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The objective of this study is to investigate the association between different volumes of accelerometer-measured moderate-to-vigorous physical activity (MVPA) and functional fitness in older adults in a cross-sectional study (n = 242; 66 ± 5 years; 80% women). MVPA was assessed by accelerometer for 1 week. Based on the MVPA recommendations, the participants were classified as: (a) inactive (<50 min/week), (b) somewhat active (50-99 min/week), (c) moderately active (100-149 min/week), and (d) active (≥150 min/week). These groups reflect <33%, 33%-66%, 67%-99%, and ≥100% of the MVPA recommendations, respectively. Functional fitness was assessed by the Senior Fitness Test battery: 6-min walk test (6MWT), timed up and go (TUG), 30-s chair stand test, 30-s arm curl test, chair sit-and-reach test, and back scratch test. In addition to the analysis for each functional fitness test, a total functional fitness score was calculated by the sum of the z scores of all tests. Generalized linear models were used for data analyses (reference: inactive). Compared with the inactive group (n = 59), the somewhat active group (n = 47) had better performance on the 6MWT and TUG (p < .05). The moderately active group (n = 47) had better performance on the 6MWT, TUG, 30-s chair stand test, and the total functional fitness score (p < .05). The active group (n = 89) had better performance on the 6MWT, TUG, 30-s chair stand test, chair sit-and-reach test, and the total functional fitness score (p < .05). Older adults who engaged in higher volumes of MVPA had better performance in more functional fitness components. However, lower than recommended volumes of MVPA (meeting ≥50 min/week) were also associated with greater lower limb functional fitness performance.

Introduction: Combined high sedentary time (ST) and low moderate-to-vigorous physical activity (MVPA) has been associated with adverse cardiovascular events. However, accurately assessing ST and MVPA in older adults is challenging in clinical practice., Purpose: To investigate whether step count can identify older adults with unhealthier movement behavior (high ST/low MVPA) and poorer cardiometabolic profile., Methods: Cross-sectional study (n = 258; 66 ± 5 years). Step count, ST, and MVPA were assessed by hip accelerometry during 7 days. The cardiometabolic profile was assessed using a continuous metabolic syndrome score (cMetS), including blood pressure, HDL-cholesterol, triglycerides, fasting glucose, and waist circumference. Receiving operating curve analysis was used to test the performance of step count in identifying older adults with unhealthier movement behavior (highest tertile of ST/lowest tertile of MVPA). Healthier movement behavior was defined as lowest tertile of ST/highest tertile of MVPA, with neutral representing the remaining combinations of ST/MVPA., Results: A total of 40 participants (15.5%) were identified with unhealthier movement behavior (ST ≥ 11.4 h/day and MVPA ≤ 10 min/day). They spent ~73% and 0.4% of waking hours in ST and MVPA, respectively. Step count identified those with unhealthier movement behavior (area under the curve 0.892, 0.850-0.934; cutoff: ≤5263 steps/day; sensitivity/specificity: 83%/81%). This group showed a higher cMetS compared with neutral (β = .25, p = .028) and healthier movement behavior groups (β = .41, p = .008)., Conclusion: Daily step count appears to be a practical, simple metric for identifying community-dwelling older adults with concomitant high ST and low MVPA, indicative of unhealthier movement behavior, who have a poorer cardiometabolic profile., (© 2024 Wiley Periodicals LLC.)

Objective: This study aimed to determine whether risk factors for presarcopenia can be identified in a sample of early middle-aged men and women., Design: Prospective study., Setting: Longitudinal data from the Dunedin Multidisciplinary Health and Development Study were used to investigate the relationship between presarcopenia at age 45 years and selected early markers at ages 26, 32, and 38 years., Participants: Longitudinal data from N=899 participants from the Dunedin Multidisciplinary Health and Development Study., Interventions: Not applicable., Main Outcome Measures: Presarcopenia was defined as low relative appendicular lean mass index assessed by dual energy x-ray absorptiometry and low strength assessed by grip strength. Logistic regressions were used to describe the association between selected markers and presarcopenia at age 45 years., Results: Multivariate logistic regression revealed that a higher body mass index (BMI) at ages 26, 32, and 38 years was associated with lower likelihood of presarcopenia at age 45 years in both men and women (odds ratio [OR] range, 0.46-0.64). Higher age-normative grip strength at age 38 years in both men and women (OR range, 0.88-0.92) was also associated with lower likelihood for presarcopenia. Lastly, lower self-perceived physical fitness level in men at age 38 years was associated with an increased likelihood of presarcopenia at age 45 years (OR, 9.35; 95% confidence interval, 3.28-26.70)., Conclusions: BMI and strength were associated with lower likelihood of presarcopenia during middle age. A higher likelihood of presarcopenia was associated with sex-specific lower self-perceived physical fitness. These modifiable biomarkers may serve as targets for clinical screening and early intervention aimed at slowing or preventing progression to sarcopenia in old age., (Copyright © 2024 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: The effects of environmental disturbances on livestock are often observed indirectly through the variability patterns of repeated performance records over time. Sheep are frequently exposed to diverse extensive environments but currently lack appropriate measures of resilience (or sensitivity) towards environmental disturbance. In this study, random regression models were used to analyse repeated records of the fibre diameter of wool taken along the wool staple (bundle of wool fibres) to investigate how the genetic and environmental variance of fibre diameter changes with different growing environments., Results: A model containing a fifth, fourth and second-order Legendre polynomial applied to the fixed, additive and permanent environmental effects, respectively, was optimal for modelling fibre diameter along the wool staple. The additive genetic and permanent environmental variance both showed variability across the staple length trajectory. The ranking of sire estimated breeding values (EBV) for fibre diameter was shown to change along the staple and the genetic correlations decreased as the distance between measurements along the staple increased. This result suggests that some genotypes were potentially more resilient towards the changes in the growing environment compared to others. In addition, the eigenfunctions of the random regression model implied the ability to change the fibre diameter trajectory to reduce its variability along the wool staple., Conclusions: These results show that genetic variation in fibre diameter measured along the wool staple exists and this could be used to provide greater insight into the ability to select for resilience in extensively raised sheep populations., (© 2024. The Author(s).)

We investigated the association of movement behavior patterns with cardiometabolic health, body composition, and functional fitness in older adults. A total of 242 older adults participated of this cross-sectional study. Sedentary time, light physical activity (LPA) and moderate-vigorous physical activity (MVPA), steps/day, and step cadence were assessed by accelerometry. The movement behavior patterns were derived by principal component analysis. Cardiometabolic health was defined by a metabolic syndrome score (cMetS). Body composition was determined by appendicular lean mass/body mass index (ALM/BMI). Functional fitness was assessed by a composite z-score from the Senior Fitness Test battery. Two patterns were identified: 'Tortoise' (low sedentary time, high LPA and steps/day) and 'Hare' (high MVPA, steps/day, and step cadence). 'Tortoise' and 'Hare' were associated with better cMetS. 'Hare' was positively associated with ALM/BMI and Functional Fitness. While 'Tortoise' and 'Hare' were associated with better cMetS, only 'Hare' was associated with better ALM/BMI and functional fitness., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: There can be variation between animals in how stable their genetic merit is across different environments due to genotype-by-environment (G×E) interactions. This variation could be used in breeding programs to select robust genotypes that combine high overall performance with stable genetic ranking across environments. There have been few attempts to validate breeding values for robustness in livestock, although this is a necessary step towards their implementation in selection decisions. The objective of this study was to validate breeding values for the robustness of body weight across different growth environments that were estimated using reaction norm models in sheep data., Results: Using threefold cross-validation for the progeny of 337 sires, the average correlation between single-step breeding values for the reaction norm slope and the realised robustness of progeny across different growth environments was 0.21. The correlation between breeding values for the reaction slope estimated independently in two different datasets linked by common sires was close to the expected correlation based on theory., Conclusions: Slope estimated breeding values (EBV) obtained using reaction norm models were predictive of the phenotypic robustness of progeny across different environments and were consistent for sires with progeny in two different datasets. Selection based on reaction norm EBV could be used to increase the robustness of a population to environmental variation., (© 2024. The Author(s).)

Background: Recent operational definitions of sarcopenia have not been replicated and compared in Australia and New Zealand (ANZ) populations. We aimed to identify sarcopenia measures that discriminate ANZ adults with slow walking speed (<0.8 m/s) and determine the agreement between the Sarcopenia Definitions and Outcomes Consortium (SDOC) and revised European Working Group for Sarcopenia in Older People (EWGSOP2) operational definitions of sarcopenia., Methods: Eight studies comprising 8 100 ANZ community-dwelling adults (mean age ± standard deviation, 62.0 ± 14.4 years) with walking speed, grip strength (GR), and lean mass data were combined. Replicating the SDOC methodology, 15 candidate variables were included in sex-stratified classification and regression tree models and receiver operating characteristic curves on a pooled cohort with complete data to identify variables and cut points discriminating slow walking speed (<0.8 m/s). Agreement and prevalence estimates were compared using Cohen's Kappa (CK)., Results: Receiver operating characteristic curves identified GR as the strongest variable for discriminating slow from normal walking speed in women (GR <20.50 kg, area under curve [AUC] = 0.68) and men (GR <31.05 kg, AUC = 0.64). Near-perfect agreement was found between the derived ANZ cut points and SDOC cut points (CK 0.8-1.0). Sarcopenia prevalence ranged from 1.5% (EWGSOP2) to 37.2% (SDOC) in women and 1.0% (EWGSOP2) to 9.1% (SDOC) in men, with no agreement (CK <0.2) between EWGSOP2 and SDOC., Conclusions: Grip strength is the primary discriminating characteristic for slow walking speed in ANZ women and men, consistent with findings from the SDOC. Sarcopenia Definitions and Outcomes Consortium and EWGSOP2 definitions showed no agreement suggesting these proposed definitions measure different characteristics and identify people with sarcopenia differently., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Gerontological Society of America.)

Objective: To map out the studies that have investigated the associations of polypharmacy and/or potentially inappropriate medication (PIM) use with physical activity and sedentary time in older adults., Methods: We conducted a literature search from inception to December 2022 in PubMed, Embase, Web of Science, and Scopus., Inclusion Criteria: observational studies including older adults (≥60 years); English, Portuguese, and Spanish languages; any definition of polypharmacy; implicit and explicit criteria of PIM use; physical activity and/or sedentary time data., Results: Fourteen cross-sectional studies were included; 11 defined polypharmacy as ≥5 medications (prevalence ranging from 9.5 % to 57 %). No study reported information on PIM use. Most studies included participants aged <80 years. Twelve studies included self-reported measures of physical activity, while two studies used accelerometer-measured physical activity. Ten studies included analyses adjusted for confounders, and nine considered polypharmacy as an outcome. All of them demonstrated an inverse association between physical activity and polypharmacy, irrespective of the definition of polypharmacy and the assessment method employed (self-reported or accelerometry). One study reported an inverse association between polypharmacy (as the exposure) and physical activity (as the outcome). None of the studies investigated the association between sedentary time and polypharmacy., Conclusions: Limited evidence suggests an inverse association between physical activity and polypharmacy in older adults. However, the relationship between PIM use, physical activity, and sedentary time remains unknown. Longitudinal studies utilizing objectively-measured physical activity and sedentary time are needed to better clarify the relationship between these movement behaviors and polypharmacy and/or PIM use in older adults., (Copyright © 2023. Published by Elsevier Inc.)

The aim of this study was to investigate the independent and joint associations of low cardiorespiratory fitness and lower-limb muscle strength with cardiometabolic risk in older adults. A total of 360 community-dwelling older adults aged 60-80 years participated in this cross-sectional study. Cardiometabolic risk was based on the diagnosis of Metabolic Syndrome and poor Ideal Cardiovascular Health according to the American Heart Association guidelines. Cardiorespiratory fitness and lower-limb muscle strength were estimated using the six-minute walk and the 30-second chair stand tests, respectively. Participants in the 20th percentile were defined as having low cardiorespiratory fitness and lower-limb muscle strength. Poisson's regression was used to determine the prevalence ratio (PR) and 95% confidence intervals (CI) of Metabolic Syndrome and poor Ideal Cardiovascular Health. Participants with low cardiorespiratory fitness alone and combined with low lower-limb muscle strength were similarly associated with a higher risk for Metabolic Syndrome (PR 1.27, 95% CI 1.09-1.48, and PR 1.32, 95% CI 1.10-1.58, respectively), and poor Ideal Cardiovascular Health (PR 1.76, 95% CI 1.25-2.47, and PR 1.65, 95% CI 1.19-2.28, respectively). Low lower-limb muscle strength alone was not associated with a higher risk for either Metabolic Syndrome or poor Ideal Cardiovascular Health (PR 1.23, 95% CI 0.81-1.87, and PR 1.11, 95% CI 0.89-1.37, respectively). Low cardiorespiratory fitness alone or combined with low lower-limb muscle strength, but not low lower-limb muscle strength alone, was associated with a higher cardiometabolic risk in older adults. The assessment of physical fitness may be a "window of opportunity" to identify youngest-old adults with a high cardiovascular disease risk., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Camara et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This study aimed to identify sociodemographic and health indicators of diet quality in pre-frail community-dwelling older adults. Pre-frail older adults are those at risk of progression to clinical manifestations of frailty and are targets for preventative intervention. We previously reported that pre-frail older adults have reasonably good overall diet quality. However, further analyses found a low intake of energy, protein and several micronutrients., Methods: We collected detailed dietary intake from pre-frail (FRAIL scale 1-2) older adults using NZ Intake24, an online version of 24 h multiple pass dietary recall. Diet quality was ascertained with the Diet Quality Index-International (DQI-I). We used regression generalized linear models to determine predictors of diet quality as well as classification and regression tree (CART) analysis to examine the complex relationships between predictors and identified profiles of sub-groups of older adults that predict diet quality., Results: The median age in this sample ( n = 468) was 80.0 years (77.0-84.0). Living with others, a high deprivation index and a higher BMI were independent predictors of poorer diet quality. With CART analysis, we found that those with a BMI > 29 kg/m 2 , living with others and younger than 80 years were likely to have a lower diet quality., Conclusions: We found that BMI, living arrangement and socioeconomic status were independent predictors of diet quality in pre-frail older adults, with BMI being the most important variable in this sample when the interaction of these variables was considered. Future research is needed to determine the similarities and/or differences in the profile of subgroups of older adults with poorer diet quality.

Background: To investigate the association of daily step volume and intensity with cardiometabolic risk in older adults., Methods: This cross-sectional study included 248 community-dwelling older adults (66.0 ± 4.6 years; 78 % females). The daily step volume and intensity were assessed using accelerometry. Cardiometabolic risk was defined using a continuous metabolic syndrome score (cMetS). The participants were categorized according to their daily step volume (inactive <5000; low active 5000-7499; active 7500-9999; highly active 10,000+ steps/day), and intensity (peak 30-min cadence; lowest, < 40; low, 40-59; average, 60-79; high, 80-99; highest, 100+ steps/min). Generalized linear models were used for data analyses., Results: The active (β = -0.29, p = 0.040) and the highly active (β = -0.40, p = 0.026) groups had lower cMetS compared to the inactive group. No significant difference was found between the low active and inactive groups (β = -0.21, p = 0.098). Every increment of 1000 steps/day was associated with a decrease of 0.06 in cMetS (p < 0.001). The average (β = -0.37, p = 0.028), high (β = -0.42, p = 0.015), and highest (β = -0.81, p = 0.001) groups had lower cMetS than the lowest group. No significant difference was observed between the low and lowest groups (β = -0.22, p = 0.192). Every increment of 10 steps/min in the peak 30-min cadence was associated with a decrease of 0.07 in cMetS (p = 0.003)., Conclusions: Daily step volume and intensity were inversely associated with cardiometabolic risk in community-dwelling older adults in a dose-response manner., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2023. Published by Elsevier Inc.)

Key Message: The reaction norm analysis of stability can be enhanced by partitioning the contribution of different types of G × E to the variation in slope. The slope of regression in a reaction norm model, where the performance of a genotype is regressed over an environmental covariable, is often used as a measure of stability of genotype performance. This method could be developed further by partitioning variation in the slope of regression into the two sources of genotype-by-environment interaction (G × E) which cause it: scale-type G × E (heterogeneity of variance) and rank-type G × E (heterogeneity of correlation). Because the two types of G × E have very different properties, separating their effect would enable a clearer understanding of stability. The aim of this paper was to demonstrate two methods which seek to achieve this in reaction norm models. Reaction norm models were fit to yield data from a multi-environment trial in Barley (Hordeum vulgare), with the adjusted mean yield from each environment used as the environmental covariable. Stability estimated from factor-analytic models, which can disentangle the two types of G × E and estimate stability based on rank-type G × E, was used for comparison. Adjusting the reaction norm slope to account for scale-type G × E using a genetic regression more than tripled the correlation with factor-analytic estimates of stability (0.24-0.26 to 0.80-0.85), indicating that it removed variation in the reaction norm slope that originated from scale-type G × E. A standardisation procedure had a more modest increase (055-0.59) but could be useful when curvilinear reaction norms are required. Analyses which use reaction norms to explore the stability of genotypes could gain additional insight into the mechanisms of stability by applying the methods outlined in this study., (© 2023. The Author(s).)

Objective: This scoping review aimed to map out currently available definitions and assessment methods of muscle quality in older adults., Design: Scoping review., Setting and Participants: All available studies., Methods: Four databases (PubMed, EMBASE, Web of Science, and Cochrane Library) were searched from inception to May 2022. Title, abstract, and full-text screening were undertaken by 2 reviewers independently. Observational and experimental studies were eligible for inclusion if there was a clear description of muscle quality assessment in individuals aged 60+ years., Results: A total of 96 articles were included. Several definitions and assessment methods of muscle quality were identified and divided into 2 main domains: (1) functional domain, and (2) morphological domain. A total of 70% and 30% of the included studies assessed muscle quality in the functional and morphological domains, respectively. In the functional domain, most studies defined muscle quality as the ratio of knee extension strength by leg lean mass (45.9%). In the morphological domain, most studies defined muscle quality as the echo intensity of quadriceps femoris by ultrasound (50.0%)., Conclusions and Implications: There is a substantial heterogeneity of definitions and assessment methods of muscle quality in older adults. Herein, we propose a standardized definition of muscle quality to include terminology, domain, and assessment methods (tests, tools, and body sites). Such standardization may help researchers, clinicians, and decision makers use muscle quality as a potential marker of "skeletal muscle health" in older adults., (Copyright © 2023 AMDA – The Society for Post-Acute and Long-Term Care Medicine. All rights reserved.)

Objectives: To develop guidelines, informed by health-care consumer values and preferences, for sarcopenia prevention, assessment and management for use by clinicians and researchers in Australia and New Zealand., Methods: A three-phase Consumer Expert Delphi process was undertaken between July 2020 and August 2021. Consumer experts included adults with lived experience of sarcopenia or health-care utilisation. Phase 1 involved a structured meeting of the Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR) Sarcopenia Diagnosis and Management Task Force and consumer representatives from which the Phase 2 survey was developed. In Phase 2, consumers from Australia and New Zealand were surveyed online with opinions sought on sarcopenia outcome priorities, consultation preferences and interventions. Findings were confirmed and disseminated in Phase 3. Descriptive statistical analyses were performed., Results: Twenty-four consumers (mean ± standard deviation age 67.5 ± 12.8 years, 18 women) participated in Phase 2. Ten (42%) identified as being interested in sarcopenia, 7 (29%) were health-care consumers and 6 (25%) self-reported having/believing they have sarcopenia. Consumers identified physical performance, living circumstances, morale, quality of life and social connectedness as the most important outcomes related to sarcopenia. Consumers either had no preference (46%) or preferred their doctor (40%) to diagnose sarcopenia and preferred to undergo assessments at least yearly (54%). For prevention and treatment, 46% of consumers preferred resistance exercise, 2-3 times per week (54%)., Conclusions: Consumer preferences reported in this study can inform the implementation of sarcopenia guidelines into clinical practice at local, state and national levels across Australia and New Zealand., (© 2022 The Authors. Australasian Journal on Ageing published by John Wiley & Sons Australia, Ltd on behalf of AJA Inc’.)

Background/objective: By having a better understanding of transitions in osteosarcopenia, interventions to reduce morbidity and mortality can be better targeted. The aim of this study was to show the rationale and method of using minimal clinically important differences (MCID's) to classify transitions, and the effects of demographic variables on transitions in a 9-year follow-up data from the New Mexico Aging Process Study (NMAPS)., Methods: Transitions were identified in four aspects of osteosarcopenia: bone mineral density (BMD), appendicular skeletal muscle mass/body mass index ratio (ASM/BMI), grip strength and gait speed. Transitions were identified using a MCID score. As there is currently no available MCID for BMD and ASM/BMI, those were determined using a distribution-based and an anchor-based method. Total transitions were calculated for all four measures of osteosarcopenia in all transition categories (maintaining a health status, beneficial transition, harmful transitions). Poisson regression was used to test for effects of demographic variables, including age, sex, physical activity, medication, and health status, on transitions., Results: Over the 9-year follow-up, a total of 2163 MCID-derived BMD transitions were reported, 1689 ASM/BMI transitions, 2339 grip strength transitions, and 2151 gait speed transitions. Additionally, some MCID-derived transition categories were associated with sex, age, and health status., Conclusion: Use of MCID-derived transitions reflected the fluctuation and the dynamic nature of health in older adults. Future research should focus on transitions of modifiable markers in osteosarcopenia to design intervention trials., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Sarcopenia is an age-associated skeletal muscle condition characterized by low muscle mass, strength, and physical performance. There is no international consensus on a sarcopenia definition and no contemporaneous clinical and research guidelines specific to Australia and New Zealand. The Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR) Sarcopenia Diagnosis and Management Task Force aimed to develop consensus guidelines for sarcopenia prevention, assessment, management and research, informed by evidence, consumer opinion, and expert consensus, for use by health professionals and researchers in Australia and New Zealand., Methods: A four-phase modified Delphi process involving topic experts and informed by consumers, was undertaken between July 2020 and August 2021. Phase 1 involved a structured meeting of 29 Task Force members and a systematic literature search from which the Phase 2 online survey was developed (Qualtrics). Topic experts responded to 18 statements, using 11-point Likert scales with agreement threshold set a priori at >80%, and five multiple-choice questions. Statements with moderate agreement (70%-80%) were revised and re-introduced in Phase 3, and statements with low agreement (<70%) were rejected. In Phase 3, topic experts responded to six revised statements and three additional questions, incorporating results from a parallel Consumer Expert Delphi study. Phase 4 involved finalization of consensus statements., Results: Topic experts from Australia (n = 62, 92.5%) and New Zealand (n = 5, 7.5%) with a mean ± SD age of 45.7 ± 11.8 years participated in Phase 2; 38 (56.7%) were women, 38 (56.7%) were health professionals and 27 (40.3%) were researchers/academics. In Phase 2, 15 of 18 (83.3%) statements on sarcopenia prevention, screening, assessment, management and future research were accepted with strong agreement. The strongest agreement related to encouraging a healthy lifestyle (100%) and offering tailored resistance training to people with sarcopenia (92.5%). Forty-seven experts participated in Phase 3; 5/6 (83.3%) revised statements on prevention, assessment and management were accepted with strong agreement. A majority of experts (87.9%) preferred the revised European Working Group for Sarcopenia in Older Persons (EWGSOP2) definition. Seventeen statements with strong agreement (>80%) were confirmed by the Task Force in Phase 4., Conclusions: The ANZSSFR Task Force present 17 sarcopenia management and research recommendations for use by health professionals and researchers which includes the recommendation to adopt the EWGSOP2 sarcopenia definition in Australia and New Zealand. This rigorous Delphi process that combined evidence, consumer expert opinion and topic expert consensus can inform similar initiatives in countries/regions lacking consensus on sarcopenia., (© 2022 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders.)

Background: Age-related loss of skeletal muscle mass and function begins in early middle age, yet research to date has focused on older individuals, limiting our understanding of interventions earlier in the lifespan. To date, no high-intensity interval training studies have been conducted in middle-aged adults with low relative lean soft tissue mass., Methods: Eighty-two middle-aged adults (40-50 years of age) with low appendicular lean soft tissue mass index confirmed with dual energy x-ray absorptiometry (DXA) were randomly allocated (1:1) to group-based, 20-week, three times a week, high-intensity aerobic and resistance training (HIART) program or 60-min education session (Control). The primary outcome was change in total lean soft tissue mass measured by DXA. Secondary outcomes included cardiorespiratory fitness, physical function (handgrip strength, gait speed, 30-seconds sit-to-stand, quadriceps strength and muscle quality). Measures were obtained at baseline (0 weeks), mid-intervention (10 weeks) and post-intervention (20 weeks)., Results: Mean age in HIART was 44.8 (SD 3.2) and 45.4 (SD 2.9) in Control group. The majority of the participants were female with 88 % in HIART and 83 % in Control group. Mean BMI in HIART was 25.8 kg/m 2 (SD 3.5) and 26.4 kg/m 2 (SD 4.1) Control group. Intention to treat analysis showed that post-intervention, HIART increased significantly more total lean soft tissue mass (0.8 kg, 95%CI 0.15, 1.46), appendicular lean soft tissue mass index (0.2 kg/m 2 , 95%CI 0.09, 0.33), peak oxygen uptake (5.18 mL/min/kg, 2.97 to 7.39 95%CI), grip strength (2.2 kg, 95%CI 0.09, 4.32), and 30-s sit-to-stand (1.3 times, 95%CI 0.43, 2.12) with significantly greater reductions in body fat percentage (-1.1 %, 95%CI -2.03, -0.10) and maximum gait speed (-0.2 m/s, 95 % CI -0.34, -0.03) compared Control., Conclusion: The HIART program is an effective exercise intervention to increase total lean soft tissue mass in middle-aged adults with low relative lean soft tissue mass compared to a waitlist control group., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate the moderating effect of step count and peak cadence on the relationship of sedentary time and cardiometabolic disease risk in community-dwelling older adults., Methods: This cross-sectional study included 248 older adults aged 60-80 years without cardiovascular disease (66.0 ± 4.6 years of age; 78 % females). Sedentary time, step count and peak cadence were measured by a hip-worn accelerometer for seven days. Peak cadence was defined as the average of 30 min of the day (but not necessarily consecutive) with the highest cadence (steps per minute) for all valid days. Cardiometabolic disease risk was defined using a sex-specific continuous metabolic syndrome score (cMetS). Sedentary time was used as an explanatory variable for cMetS and step count and peak cadence as moderators. The analyses were adjusted for known cardiometabolic disease risk factors and accelerometer wear time. The Johnson-Neyman technique was used to specify the value of moderator variables at which the significant relationship between sedentary time and cMetS disappears., Results: Both step count (β = -0.186, P = 0.032) and peak cadence (β = -0.003, P = 0.007) showed a moderating effect on the relationship of sedentary time and cMetS. The association of sedentary time and cMetS was not statistically significant (p > 0.05) when step count or peak cadence exceed 5715 steps per day and 57 steps per minute, respectively., Conclusion: Steps per day and peak cadence moderate the association of sedentary time and cardiometabolic disease risk in older adults. Therefore, steps per day and peak cadence seem to offset the deleterious effects of sedentary time on cardiometabolic health in this population., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objectives: To explore the impacts of the 2020 New Zealand COVID-19 lockdown on peer-led Steady as You Go (SAYGO) fall prevention exercise classes and members, and to develop recommendations for mitigating impacts during future lockdowns., Methods: Semi-structured phone interviews were conducted with 20 SAYGO program participants and managers following the first COVID-19 lockdown in New Zealand. Interviews were audio-recorded, transcribed verbatim and analysed using the General Inductive Approach., Results: Participants were between 67 and 88 years of age, predominantly female (90%) and NZ European (80%), with one participant identifying as NZ Māori. Three themes were constructed from the analysis: Personal Function and Well-Being, Class Functioning and Logistics, and Future Strategies for Classes During Prospective Lockdowns. Participants used a range of strategies to stay connected with each other and continue the SAYGO exercises at home. Most participants and peer-leaders reported that they maintained physical function during lockdown, although some had feelings of psychological distress and social isolation. Contact systems and resource distribution varied substantially between groups. Classes resumed post-lockdown with only minor modifications and slightly decreased attendance., Conclusions: Overall, members of this peer-led model of fall prevention classes demonstrated resilience during the COVID-19 lockdown, despite some challenges. We propose three recommendations to address the challenges of maintaining existing peer-led exercise classes in the context of prospective lockdowns: (1) develop a comprehensive contact detail register and plans for each group; (2) delivery of modified exercise classes remotely over lockdown; and (3) implementation of a nationwide IT education and resource program for older adults., (© 2022 The Authors. Australasian Journal on Ageing published by John Wiley & Sons Australia, Ltd on behalf of AJA Inc’.)

Background: When a Zuni elder sustains a fall-related injury, the closest tribal skilled nursing facility is 100 miles from the Pueblo and no physical therapy services are available. Thus, fall prevention strategies as a primary intervention to avert injurious falls and preserve aging in place are needed. The objective of the study is to compare the effectiveness of a community health representative (CHR)-delivered, culturally-adapted Otago Exercise Program (OEP) fall prevention program compared to the standard of care education-based fall risk management., Methods: "Standing Strong in Tribal Communities: Assessing Elder Falls Disparity" is mixed-methods research with a randomized controlled trial. The CHRs will be trained to deliver the culturally-adapted OEP trial and offer advantages of speaking "Shiwi" (Zuni tribal language) and understanding Zuni traditions, family structures, and elders' preferences for receiving health information. Focus groups will be conducted to assure all materials are culturally appropriate, and adapted. A physical therapist will train CHRs to screen elders for falls risk and to deliver the OEP to the intervention group and education to the control group. Up to 400 Zuni elders will be screened by the CHRs for falls risk and 200 elders will be enrolled into the study (1:1 random allocation by household). The intervention is 6 months with measurements at baseline, 3, 6 and 12 months. The primary outcome is improved strength and balance (timed up and go, sit to stand and 4 stage balance test), secondary outcomes include falls incidence, self-efficacy using Attitudes to Falls-Related Interventions Scale, Medical Outcomes Study Short Form 12 (SF-12v2) and Self-Efficacy for Managing Daily Activities., Discussion: Fall prevention for Zuni elders was identified as a tribal priority and this trial is built upon longstanding collaborations between the investigative team, Zuni tribal leaders, and multiple tribal health programs. Delivery by the CHRs make this model more acceptable, and thus, more sustainable long term. This study has the potential to change best practice for elder care in tribal and rural areas with limited access to physical therapist-delivered fall prevention interventions and aligns with tribal goals to avert fall-related injury, reduce healthcare disparity, and preserve elder's independence., Trial Registration: NCT04876729., (© 2022. The Author(s).)

Background: The increasing prevalence of frailty with age is becoming a public health priority in countries with ageing populations. Pre-frailty presents a window of opportunity to prevent the development of frailty in community-dwelling older adults. This study aimed to examine the effectiveness of a complex intervention that combined a nutrition-based intervention and a physical activity intervention, along with the effectiveness of each intervention individually, to reduce physical frailty in pre-frail older adults over 2 years., Methods: In this single-blind, 2 x 2 factorial, randomised, controlled trial, we recruited pre-frail community-dwelling older adults in Aotearoa New Zealand via mail through general medical practices. To be eligible, participants had to be pre-frail according to self-reported FRAIL scores of 1 or 2, aged 75 years or older (or 60 years or older for Māori and Pacific Peoples), not terminally ill or with advanced dementia as judged by a general practitioner, able to stand, medically safe to participate in low-intensity exercise, and able to use kitchen utensils safely. Participants were randomly allocated to receive an 8-week Senior Chef programme (SC group), a 10-week Steady As You Go programme (SAYGO group), a 10-week combined SC and SAYGO intervention (combined group), or a 10-week social programme (control group), using computer-generated block randomisation administered through an electronic data capture system by local study coordinators. Assessors were masked to group allocation for all assessments. SC is a group-based nutrition education and cooking class programme (3 h weekly), SAYGO is a group-based strength and balance exercise programme (1 h weekly), and the social control programme was a seated, group socialising activity (once a week). Masked assessors ascertained Fried frailty scores at baseline, end of intervention, and at 6, 12, and 24 months after the programme. The primary outcome was change in Fried frailty score at 2 years. Intention-to-treat analyses were completed for all randomised participants, and all participants who had a high (≥75%) adherence were analysed per protocol. This study is registered at ANZCTR, ACTRN12614000827639., Findings: Between May 12, 2016 and April 9, 2018, we assessed 2678 older adults for eligibility, of whom 468 (17%) consented and completed baseline assessment, with a mean age of 80·3 years (SD 5·1) and a mean Fried score of 1·9 (1·2); 59% were women. We randomly allocated these participants into the four groups: 117 in the SC group, 118 in the SAYGO group, 118 in the combined group, and 115 in the control group; 318 participants attended the 24-month follow-up: 89 in the SC group, 78 in the SAYGO group, 73 in the combined group, and 78 in the control group. At the 24-month follow-up, there were no differences in mean Fried scores between the intervention groups and the control group. No adverse events were reported., Interpretation: The study did not find that the combined SC and SAYGO programme was effective in reducing frailty in pre-frail older adults. Although some short-term benefits were observed in each individual programme, there was no clear evidence of long-term impact. Further research is needed to evaluate combinations of group-based programmes for community-dwelling older adults to optimise their physical function., Funding: Health Research Council New Zealand and Ageing Well Challenge (Ministry of Business Innovation and Employment)., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: Selection of livestock based on their robustness or sensitivity to environmental variation could help improve the efficiency of production systems, particularly in the light of climate change. Genetic variation in robustness arises from genotype-by-environment (G × E) interactions, with genotypes performing differently when animals are raised in contrasted environments. Understanding the nature of this genetic variation is essential to implement strategies to improve robustness. In this study, our aim was to explore the genetics of robustness in Australian sheep to different growth environments using linear reaction norm models (RNM), with post-weaning weight records of 22,513 lambs and 60 k single nucleotide polymorphisms (SNPs). The use of scale-corrected genomic estimated breeding values (GEBV) for the slope to account for scale-type G × E interactions was also investigated., Results: Additive genetic variance was observed for the slope of the RNM, with genetic correlations between low- and high-growth environments indicating substantial re-ranking of genotypes (0.44-0.49). The genetic variance increased from low- to high-growth environments. The heritability of post-weaning body weight ranged from 0.28 to 0.39. The genetic correlation between intercept and slope of the reaction norm for post-weaning body weight was low to moderate when based on the estimated (co)variance components but was much higher when based on back-solved SNP effects. An initial analysis suggested that a region on chromosome 11 affected both the intercept and the slope, but when the GEBV for the slope were conditioned on the GEBV for the intercept to remove the effect of scale-type G × E interactions on SNP effects for robustness, a single genomic region on chromosome 7 was found to be associated with robustness. This region included genes previously associated with growth traits and disease susceptibility in livestock., Conclusions: This study shows a significant genetic variation in the slope of RNM that could be used for selecting for increased robustness of sheep. Both scale-type and rank-type G × E interactions contributed to variation in the slope. The correction for scale effects of GEBV for the slope should be considered when analysing robustness using RNM. Overall, robustness appears to be a highly polygenic trait., (© 2022. The Author(s).)

Background: The use of telehealth has increased since the COVID-19 pandemic; however, the lack of reliable and valid tools to measure balance and gait remotely makes assessing these outcomes difficult. Thus, we investigated whether balance and gait measures used in clinical practice are reliable and valid when assessed remotely through telehealth., Method: In this pilot study, we investigated 15 healthy older adults who performed validated tests: Timed Up and Go simple, dual cognitive and motor tasks; Berg Balance Scale; Functional Gait Assessment and Dynamic Gait Index. The tests were assessed on two dates: (i) face-to-face, (ii) and remotely, via videoconference between 7 and 14 days after the initial assessment. Participants also undertook the Physiological Profile Assessment (PPA) to assess their risk of falling. Reliability was measured using intraclass correlation (ICC) two-way mixed with absolute agreement to contrast the score of the assessments undertaken face-to-face and remotely in real-time and recorded. We also assessed inter-rater reliability. Criterion validity was measured using Pearson correlation between the tests that were undertaken remotely and PPA., Results: All tests showed good reliability between face-to-face and real-time telehealth (ICC = 0.79-0.87) and face-to-face and recorded telehealth (ICC = 0.78-0.88) assessments and good to excellent inter-rater reliability (ICC = 0.80-1.00). Correlation between the tests and PPA were significantly (p < 0.05) moderate for real-time (r = -0.68-0.64) and recorded (r = -0.69-0.71) telehealth assessments., Conclusions: The good reliability between face-to-face and remote measurements together with moderate validity of these measures to assess fall risk suggest that health professionals could use these measures to evaluate the balance and gait of healthy older adults remotely., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: To investigate the impact of New Zealand's (NZ) first wave of COVID-19, which included a nationwide lockdown, on the health and psychosocial well-being of Māori, Pacific Peoples and NZ Europeans in aged residential care (ARC)., Methods: interRAI assessments of Māori, Pacific Peoples and NZ Europeans (aged 60 years and older) completed between 21/3/2020 and 8/6/2020 were compared with assessments of the same ethnicities during the same period in the previous year (21/3/2019 to 8/6/2019). Physical, cognitive, psychosocial and service utilisation indicators were included in the bivariate analyses., Results: A total of 538 Māori, 276 Pacific Peoples and 11,322 NZ Europeans had an interRAI assessment during the first wave of COVID-19, while there were 549 Māori, 248 Pacific Peoples and 12,367 NZ Europeans in the comparative period. Fewer Māori reported feeling lonely (7.8% vs. 4.5%, p = 0.021), but more NZ Europeans reported severe depressive symptoms (6.9% vs. 6.3%, p = 0.028) during COVID-19. Lower rates of hospitalisation were observed in Māori (7.4% vs. 10.9%, p = 0.046) and NZ Europeans (8.1% vs. 9.4%, p < 0.001) during COVID-19., Conclusions: We found a lower rate of loneliness in Māori but a higher rate of depression in NZ European ARC populations during the first wave of COVID-19. Further research, including qualitative studies with ARC staff, residents and families, and different ethnic communities, is needed to explain these ethnic group differences. Longer-term effects from the COVID-19 pandemic on ARC populations should also be investigated., (© 2021 AJA Inc.)

Background: Obesity exacerbates age-related effects on body composition and physical and metabolic function. Which exercise mode is most effective in mitigating these deleterious changes in dieting older adults with obesity is unknown., Methods: In a randomized controlled trial, we performed a head-to-head comparison of aerobic (AEX), resistance (REX), or combination (COMB) exercise during matched ~10% weight loss in 160 obese older adults. Prespecified analyses compared 6-month changes in intermuscular adipose tissue (IMAT) and visceral adipose tissue (VAT) assessed using MRI, insulin sensitivity index (ISI) by oral glucose tolerance test, physical function using Modified Physical Performance Test (PPT), VO2peak, gait speed, and knee strength by dynamometry., Results: IMAT and VAT decreased more in COMB than AEX and REX groups (IMAT; -41% vs -28% and -23% and VAT: -36% vs -19% and -21%; p = .003 to .01); IMAT and VAT decreased in all groups more than control (between-group p < .001). ISI increased more in COMB than AEX and REX groups (86% vs 50% and 39%; p = .005 to .03). PPT improved more in COMB than AEX and REX groups, while VO2peak improved more in COMB and AEX than REX group (all p < .05). Knee strength improved more in COMB and REX than AEX group (all p < .05). Changes in IMAT and VAT correlated with PPT (r = -0.28 and -0.39), VO2peak (r = -0.49 and -0.52), gait speed (r = -0.25 and -0.36), and ISI (r = -0.49 and -0.52; all p < .05)., Conclusions: Weight loss plus combination aerobic and resistance exercise was most effective in improving ectopic fat deposition and physical and metabolic function in older adults with obesity., (Published by Oxford University Press on behalf of The Gerontological Society of America 2021.)

This study aimed to describe the diet quality of pre-frail community-dwelling older adults to extend the evidence of nutrition in frailty prevention. Pre-frailty, the transition state between a robust state and frailty, was ascertained using the FRAIL scale. Socio-demographic, health status, and 24-h dietary recalls were collected from 465 community-dwelling adults aged 75+ (60 years for Māori and Pacific people) across New Zealand. Diet quality was ascertained with the Diet Quality Index-International (DQI-I). Participants (median (IQR) age 80 (77-84), 59% female) had a moderately healthful diet, DQI-I score: 60.3 (54.0-64.7). Women scored slightly higher than men ( p = 0.042). DQI-I components identified better dietary variety in men ( p = 0.044), and dietary moderation in women ( p = 0.002); both sexes performed equally well in dietary adequacy and poorly in dietary balance scores (73% and 47% of maximum scores, respectively). Low energy 20.3 (15.4-25.3) kcal/kg body weight (BW) and protein intakes 0.8 (0.6-1.0) g/kg BW were coupled with a high prevalence of mineral inadequacies: calcium (86%), magnesium (68%), selenium (79%), and zinc (men 82%). In conclusion, the diet quality of pre-frail older adults was moderately high in variety and adequacy but poor in moderation and balance. Our findings support targeted dietary interventions to ameliorate frailty.

Objective: This study aims to appraise and summarize consistent recommendations from clinical practice guidelines (CPGs) for identification and management of frailty to maintain and improve functional independence of elderly population., Methods: A systematic search of Ovid MEDLINE, Embase, PubMed, PsycINFO, and CINAHL electronic databases using database-specific search terms in two broad areas "guidelines" and "frailty", and a manual search of websites with the key phrase "frailty guideline" was performed. The inclusion criteria included CPGs focusing on identifying and managing frailty in population >65 years old, published in English since January 2010. Three reviewers independently assessed guideline quality using the AGREE II instrument. Data extraction was performed, followed by compilation and comparison of all recommendations to identify the key consistent recommendations., Results: Six CPGs met the inclusion criteria; however, only three CPGs had high methodological quality in accordance with AGREE II appraisal. The average AGREE II scores of all six CPGs were: 84.5%, 68%, 46.5%, 81.5%, 56.3%, and 60.2% for domains 1-6 (scope and purpose, stakeholder involvement, rigour of development, clarity of presentation, applicability, and editorial independence) respectively. A total of 54 recommendations were identified, with 12 key recommendations suggested frequently by the CPGs., Conclusion: The AGREE II instrument identified strengths and weaknesses of the CPGs, but failed to assess clinical implications and feasibility of the guidelines. Further research is needed to improve clinical relevance of CPGs in the identification and management of frailty. The feasibility in implementing these guidelines with regards to cost-effectiveness of frailty screening warrants further investigation., Competing Interests: None declared.

The human ageing process is universal, ubiquitous and inevitable. Every physiological function is being continuously diminished. There is a range between two distinct phenotypes of ageing, shaped by patterns of living - experiences and behaviours, and in particular by the presence or absence of physical activity (PA) and structured exercise (i.e., a sedentary lifestyle). Ageing and a sedentary lifestyle are associated with declines in muscle function and cardiorespiratory fitness, resulting in an impaired capacity to perform daily activities and maintain independent functioning. However, in the presence of adequate exercise/PA these changes in muscular and aerobic capacity with age are substantially attenuated. Additionally, both structured exercise and overall PA play important roles as preventive strategies for many chronic diseases, including cardiovascular disease, stroke, diabetes, osteoporosis, and obesity; improvement of mobility, mental health, and quality of life; and reduction in mortality, among other benefits. Notably, exercise intervention programmes improve the hallmarks of frailty (low body mass, strength, mobility, PA level, energy) and cognition, thus optimising functional capacity during ageing. In these pathological conditions exercise is used as a therapeutic agent and follows the precepts of identifying the cause of a disease and then using an agent in an evidence-based dose to eliminate or moderate the disease. Prescription of PA/structured exercise should therefore be based on the intended outcome (e.g., primary prevention, improvement in fitness or functional status or disease treatment), and individualised, adjusted and controlled like any other medical treatment. In addition, in line with other therapeutic agents, exercise shows a dose-response effect and can be individualised using different modalities, volumes and/or intensities as appropriate to the health state or medical condition. Importantly, exercise therapy is often directed at several physiological systems simultaneously, rather than targeted to a single outcome as is generally the case with pharmacological approaches to disease management. There are diseases for which exercise is an alternative to pharmacological treatment (such as depression), thus contributing to the goal of deprescribing of potentially inappropriate medications (PIMS). There are other conditions where no effective drug therapy is currently available (such as sarcopenia or dementia), where it may serve a primary role in prevention and treatment. Therefore, this consensus statement provides an evidence-based rationale for using exercise and PA for health promotion and disease prevention and treatment in older adults. Exercise prescription is discussed in terms of the specific modalities and doses that have been studied in randomised controlled trials for their effectiveness in attenuating physiological changes of ageing, disease prevention, and/or improvement of older adults with chronic disease and disability. Recommendations are proposed to bridge gaps in the current literature and to optimise the use of exercise/PA both as a preventative medicine and as a therapeutic agent., Competing Interests: Dr. Anker reports grants and personal fees from Vifor Int, personal fees from Bayer, personal fees from Boehringer Ingelheim, personal fees from Servier, grants and personal fees from Abbott Vascular, personal fees from Cardiac Dimensions, personal fees from Actimed, personal fees from Astra Zeneca, personal fees from Amgen, personal fees from Bioventrix, personal fees from Janssen, personal fees from Respicardia, personal fees from V-Wave, personal fees from Brahms, personal fees from Cordio, personal fees from Occlutech, outside the submitted work. Dr. Ruiz reports grants from Longeveron Inc, outside the submitted work. Dr. Marzetti reports personal fees from Abbott, personal fees from Nestlè, personal fees from Nutricia, personal fees from ThermoFisher, outside the submitted work. All the other authors have nothing to disclose.

Background: Sarcopenia is the age-related loss of skeletal muscle mass and function and may exist in early middle age. Previous research in this area has focused on resistance training in older individuals; however, there is a lack of intervention trials in middle-aged adults with low relative appendicular lean soft tissue mass who may be at risk for sarcopenia in older age., Objective: This randomized controlled trial aims to determine the effects of a high-intensity interval aerobic resistance training intervention on appendicular lean soft tissue mass in middle-aged adults with low relative appendicular lean soft tissue mass., Methods: We will conduct a 40-week, single-blinded randomized controlled trial in 84 middle-aged adults with low appendicular lean soft tissue mass in the wider Dunedin area, New Zealand. We will randomly allocate participants to receive either a group-based, 20-week high-intensity interval aerobic resistance training intervention program or a single, 60-minute education session on current exercise recommendations. After the first 20 weeks, both groups will be given a 20-week home program. The study will assess primary and secondary outcome measures, including body composition (regional and whole-body lean soft tissue mass, fat mass, percentage body fat, measured by dual x-ray absorptiometry), blood biomarkers (cortisol, creatinine, C-reactive protein, lipid profile, hemoglobin), physical fitness (maximum oxygen consumption, blood pressure), physical activity (accelerometry), physical function (handgrip strength, sit-to-stand, gait speed, quadriceps strength), and self-reported questionnaires (health outcomes, self-efficacy, perceived enjoyment of physical activity, and multifactorial lifestyle), at baseline, 20 weeks, and 40 weeks. Physical function and self-reported questionnaires will also be measured at 10 weeks. We will assess the primary outcome measure, total body lean soft tissue mass, at baseline, 20 weeks, and 40 weeks. Analyses will be performed using intention-to-treat principles, comparing the outcomes resulting from the intervention, using linear mixed models., Results: We obtained ethical approval for this study from The University of Otago Human Ethics Committee on December 10, 2018. Participant recruitment started on February 11, 2019 and was completed on May 14, 2019. Data collection started on February 25, 2019 and was completed on February 28, 2020. We expect to publish the results in January 2021., Conclusions: High-intensity interval aerobic resistance training is a time-efficient form of exercise, enabling busy middle-aged adults to meet physical activity recommendations while maximizing training results. The findings can inform the development of future prevention-focused interventions aimed at counteracting the high prevalence of sarcopenia in the aging population., Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN12618001778279); https://tinyurl.com/y555z6fz., International Registered Report Identifier (irrid): DERR1-10.2196/22989., (©Lara Vlietstra, Debra L Waters, Lynnette M Jones, Kim Meredith-Jones. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 16.10.2020.)

Aotearoa-New Zealand is expecting the number of older adults to double in the next 20 years. Despite publicly funded health and welfare support for older citizens, the aging experience differs across ethnic groups. This creates opportunities and challenges for health and social services to deliver culturally safe and equitable care for all older New Zealanders. Longitudinal and large data sets are pivotal for characterizing the aging experience from birth to advanced age. The New Zealand research funding system responded to predicted demographic changes by increasing funding in order to inform and address key health and well-being issues for older people. In addition, government strategies and policies increasingly focus on social aspects of aging and health inequities and require researchers and organizations to be better connected to end-users. New Zealand needs to continue to fund research that identifies unique and courageous service delivery solutions that result in positive social, financial, psychological, and physical aging for older New Zealanders., (© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America.)

Physical frailty and cognitive frailty share biological mechanisms, but sex-specific biomarkers associated with transitions in gait speed and cognition during ageing are poorly understood.Gait speed, cognition (3MSE), body composition (DXA) and serological biomarkers were assessed annually over 9 years in 216 males (72.7 + 8.07 years) and 384 females (71.1 + 8.44 years). In females, maintaining normal gait speed was associated with lower percent body fat (IRR 0.793, p = 0.001, 95%CI 0.691-0.910) and lower lactate dehydrogenase (LDH) (IRR 0.623, p = 0.00, 95%CI 0.514-0.752), and in males, the association was with higher cholesterol (IRR 1.394, p = 0.001, 95%CI 1.154-1.684). Abnormal to normal gait speed transitions were associated with higher insulin in females (IRR 1.325, p = 0.022, 95%CI 1.041-1.685) and lower creatinine in males (IRR 0.520, p = 0.01, 95%CI 0.310-0.870). Normal to slow gait speed transitions in males were associated with IGF-1 (IRR 1.74, p = 0.022, 95%CI 1.08-2.79) and leptin in females (IRR 1.39, p = 0.043, 95%CI 1.01-1.91.) Maintaining normal cognition was associated with lower LDH in females (IRR 0.276, p = 0.013, 95%CI 0.099-0.765) and higher appendicular skeletal muscle mass in males (IRR 1.52, p = 0.02, 95%CI 1.076-2.135). Improved cognition was associated with higher leptin (IRR 7.5, p = 0.03, 95%CI 1.282-44.34) and lower triglyceride (IRR 0.299, p = 0.017, 95%CI 0.110-0.809) in males. Education was protective against cognitive decline in females (IRR 0.84, p = 0.037, 0.732-0.982). Sex-specific biomarkers of muscle (LDH, Creatinine, IGF-1, APSM) and metabolism (%fat, insulin,cholesterol, leptin, tryglycerides) were associated with gait speed and cognitive transitions. These data suggest that modifiable biomarkers of muscle and metabolism could be targeted for interventions.

Weight loss therapy of older adults with obesity is limited by weight loss-induced decrease in bone mineral density (BMD), which could exacerbate ongoing age-related bone loss and increase the risk for fractures. Therefore, it is recommended that weight loss therapy of older adults with obesity should include an intervention such as regular exercise to reduce the concomitant bone loss. However, the most appropriate exercise types to combine with weight loss therapy in this older population is unknown. In a randomized controlled trial, we performed a head-to-head comparison of aerobic or resistance exercise, or both, during matched ~10% weight loss in 160 older adults with obesity. We measured changes in BMD (total hip, femoral neck, trochanter, intertrochanter, one-third radius, lumbar spine) and bone markers. Changes between groups were analyzed using mixed-model repeated measures analyses of variance. After 6 months of intensive lifestyle interventions, BMD decreased less in the resistance group (-0.006 g/cm 2 [-0.7%]) and combination group (-0.012 g/cm 2 [-1.1%]) than in the aerobic group (-0.027 g/cm 2 [-2.6%]) (p = 0.001 for between-group comparisons). Serum C-telopeptide, procollagen type 1 N-propeptide, and osteocalcin concentrations increased more in the aerobic group (33%, 16%, and 16%, respectively) than in the resistance group (7%, 2%, and 0%, respectively) and combination group (11%, 2%, and 5%, respectively) (p = 0.004 to 0.048 for between-group comparisons). Multiple regression analyses revealed that the decline in whole body mass and serum leptin were the independent predictors of the decline in hip BMD (multiple R = 0.45 [p < .001]). These findings indicate that compared with aerobic exercise, resistance and combined aerobic and resistance exercise are associated with less weight loss-induced decrease in hip BMD and less weight loss-induced increase in bone turnover. Therefore, both resistance and combined aerobic and resistance exercise can be recommended to protect against bone loss during weight loss therapy of older adults with obesity. (LITOE ClinicalTrials.gov number NCT01065636.) © 2019 American Society for Bone and Mineral Research. Published 2019. This article is a U.S. Government work and is in the public domain in the USA., (Published 2019. This article is a U.S. Government work and is in the public domain in the USA.)

Competing Interests: No Conflicts of Interest: ACJ, BD, BV, CT, CWW, HA, IA, JohnB, Justin B, JGR, JL, JW, LuigiF, LeonF, LKC, LR-M, MAL, MS, PSB, RAM, YR, JV. SA: Reports grant from EU programs, Fondation de l/avenir, and the AMPA and France Alzheimer Associations; personal fees from Nestlé, Nestec SA, Sanofi, and MSD; and non-financial support from Biogen, Pfizer, and Icon outside the submitted work. ED: Supported by an Australian NHMRC Early Career Fellowship (#112672); MC: Honoraria for presentations at Scientific meetings and for serving as expert consultant for Nestlé. RF: Dr. Fielding reports grants from National Institutes of health (National Institute on Aging), during the conduct of the study; grants, personal fees and other from Axcella Health, stock options from Inside Tracker, grants and personal fees from Biophytis, grants and personal fees from Astellas personal fees from Cytokinetics, personal fees from Amazentis, grants and personal fees from Nestle’, personal fees from Glaxo Smith Kline, outside the submitted work. Also: This work is supported in part by the US Department of Agriculture, under agreement no. 58-1950-4-003. JYR: Consulting fees or paid advisory boards: IBSA-GENEVRIER, MYLAN, RADIUS HEALTH, PIERRE FABRE, FAES PHARMA, REJUVENATE BIOMED, SAMUMED, TEVA, THERAMEX, PFIZER, MITHRA PHARMACEUTICALS. Lecture fees when speaking at the invitation of sponsor: IBSA-GENEVRIER, MYLAN, CNIEL, DAIRY RESEARCH COUNCIL (DRC), NUTRICIA, DANONE, AGNOVOS. Grant Support from Industry (All through Institution): IBSA-GENEVRIER, MYLAN, CNIEL, RADIUS HEALTH, TRB. JMB: Consulting fees or paid advisory boards: Danone Nutricia, Nestlé, Bayer, Rejuvenate Biomed, Daiichi Sankyo; Lecture fees: Nutricia Danone, Nestlé, Fresenius, Pfizer, Novartis, Bayer. All income from the above goes to JMB’s institution. DLW: Consulting fees or paid advisory boards: Danone Nutricia.

Background: Frailty is a multidimensional geriatric syndrome associated with functional loss. The Senior Chef (SC, nutrition) and SAYGO (strength and balance exercise) programmes are well accepted among older adults but the impact of each, or a combination of both, on the frailty syndrome in pre-frail older adults is unknown., Aims: To determine the effectiveness and cost-effectiveness of a complex intervention consisting of the SC and/or SAYGO programmes to prevent progression of frailty in pre-frail older adults., Methods: A multi-centre randomised controlled assessor-blinded study. The four intervention groups are SC, an 8-week nutrition education and cooking class; SAYGO, a 10-week strength and balance exercise class; SC plus SAYGO, and a social group (Control). Community-dwelling adults aged 75+ (60 + Māori and Pasifika) in New Zealand are recruited through health providers. Participants are not terminally ill or with advanced dementia, and have a score of 1 or 2 on the FRAIL questionnaire. Baseline assessments are completed using standardised questionnaires prior to randomisation. Four follow-up assessments are completed: immediately after intervention, 6, 12 and 24 months post-intervention. The primary outcome is frailty score, secondary outcomes are falls, physical function, quality of life, food intake, physical activity, and sustainability of the strategy. Study outcomes will be analysed using intention-to-treat approach. Cost analyses will be completed to determine if interventions are cost effective relative to the control group., Discussion: This trial is designed to be a real world rigorous assessment of whether the two intervention strategies can prevent progression of frailty in older people. If successful, this will generate valuable information about effectiveness of this nutrition and exercise strategy, and provide insights for their implementation., Trial Registration: Australian and New Zealand Clinical Trials Registry number-ACTRN12614000827639.