The aim of this study was to examine the association of sedentary behaviour patterns with frailty in older people.
Clinical setting.
Cross-sectional, observational study.
A triaxial accelerometer was ...used in a subsample from the Toledo Study for Healthy Aging (519 participants, 67-97 years) to assess several sedentary behaviour patterns including sedentary time per day, the number and duration (min) of breaks in sedentary time per day, and the proportion of the day spent in sedentary bouts of 10 minutes or more. Frailty was assessed using the Frailty Trait Scale (FTS). Regression analysis was used to ascertain the associations between sedentary behaviour patterns and frailty.
Sedentary time per day and the proportion of the day spent in sedentary bouts of 10 minutes or more, were positively associated with frailty in the study sample. Conversely, the time spent in breaks in sedentary time was negatively associated with frailty.
In summary, breaking up sedentary time and time spent in sedentary behaviour are associated with frailty in older people.
Oxidative stress is associated with disease severity and limb muscle dysfunction in COPD. Our main goal was to assess the effects of exercise training on systemic oxidative stress and limb muscle ...dysfunction in older people with COPD. Twenty‐nine outpatients with COPD (66‐90 years) were randomly assigned to a 12‐week exercise training (ET; high‐intensity interval training (HIIT) plus power training) or a control (CT; usual care) group. We evaluated mid‐thigh muscle cross‐sectional area (CSA; computed tomography); vastus lateralis (VL) muscle thickness, pennation angle, and fascicle length (ultrasonography); peak VO2 uptake (VO2peak) and work rate (Wpeak) (incremental cardiopulmonary exercise test); rate of force development (RFD); maximal muscle power (Pmax; force‐velocity testing); systemic oxidative stress (plasma protein carbonylation); and physical performance and quality of life. ET subjects experienced changes in mid‐thigh muscle CSA (+4%), VL muscle thickness (+11%) and pennation angle (+19%), VO2peak (+14%), Wpeak (+37%), RFD (+32% to 65%), Pmax (+38% to 51%), sit‐to‐stand time (−24%), and self‐reported health status (+20%) (all P < 0.05). No changes were noted in the CT group (P > 0.05). Protein carbonylation decreased among ET subjects (−27%; P < 0.05), but not in the CT group (P > 0.05). Changes in protein carbonylation were associated with changes in muscle size and pennation angle (r = −0.44 to −0.57), exercise capacity (r = −0.46), muscle strength (r = −0.45), and sit‐to‐stand performance (r = 0.60) (all P < 0.05). The combination of HIIT and power training improved systemic oxidative stress and limb muscle dysfunction in older people with COPD. Changes in oxidative stress were associated with exercise‐induced structural and functional adaptations.
Muscle power has been proposed to be the primary therapeutic target for resistance training interventions aimed at enhancing physical function in older adults. However, no recommendations exist on ...ideal testing protocols to assess muscle power in older adults, and the safety of this procedure has not been adequately evaluated in the literature.
A systematic review was conducted to identify studies evaluating muscle power exerted by older people in resistance exercises through May 2017. Information from muscle power testing protocols regarding familiarization, warm-up, measuring instrument, exercise, intensity, volume, rest intervals, data collection, and analysis was collected, as well as that regarding adverse events. Reporting bias was evaluated according to the recommendations given by the Cochrane Collaboration group.
From 65 studies that met inclusion criteria, 3,484 older subjects and 11,841 muscle power tests distributed in 6,105 testing sessions were identified. A full description of the different muscle power testing protocols was conducted. In addition, a risk of adverse events of 0.15%-0.69% (one adverse event every 144-658 muscle power tests) was found. However, adverse events were poorly reported, with most of the studies showing a high risk of reporting bias.
Major discrepancies were found in muscle power testing protocols among studies. This might limit consensus on designing optimal training programs to improve muscle power and physical function in older adults, and understanding the main mechanisms involved in the age-related loss of muscle power. Finally, muscle power testing was found to be safe in older people with a broad range of health and functional states.
Objective
This study aimed to assess the residual effects of a 12‐week concurrent training program (power training + high‐intensity interval training) in older adults with chronic obstructive ...pulmonary disease (COPD).
Methods
A total of 21 older adults with COPD intervention (INT), n = 8; control (CON), n = 13; 76.9 ± 6.8 years were assessed at baseline and 10 months after the completion of the intervention by the short physical performance battery (SPPB), health‐related quality of life (EQ‐5D‐5L), vastus lateralis muscle thickness (MT), peak pulmonary oxygen uptake (peak VO2) and peak work rate (Wpeak), early and late isometric rate of force development (RFD), leg and chest press maximum muscle power (LPmax and CPmax), and systemic oxidative damage and antioxidant capacity.
Results
Compared to baseline, after 10 months of detraining, the INT group presented increased SPPB (∆ = 1.0 point), health‐related quality of life (∆ = 0.07 points), early RFD (∆ = 834 N∙s−1), LPmax (∆ = 62.2 W), and CPmax (∆ = 16.0 W) (all p < 0.05). In addition, a positive effect was noted in INT compared to CON regarding MT and Wpeak (both p < 0.05). No between‐group differences were reported in peak VO2, late RFD, systemic oxidative damage, and antioxidant capacity from baseline to 10 months after the completion of the intervention (all p > 0.05).
Conclusions
Twelve weeks of concurrent training were enough to ensure improved physical function, health‐related quality of life, early RFD and maximum muscle power and to preserve MT and Wpeak but not peak VO2, late RFD, systemic oxidative damage and antioxidant capacity in the subsequent 10 months of detraining in older adults with COPD.
OBJECTIVE:The aim of this study was to compare and validate the different classifications of severity in acute pancreatitis (AP) and to investigate which characteristics of the disease are associated ...with worse outcomes.
SUMMARY OF BACKGROUND DATA:AP is a heterogeneous disease, ranging from uneventful cases to patients with considerable morbidity and high mortality rates. Severity classifications based on legitimate determinants of severity are important to correctly describe the course of disease.
METHODS:A prospective multicenter cohort study involving patients with AP from 23 hospitals in Spain. The Atlanta Classification (AC), Revised Atlanta Classification (RAC), and Determinant-based Classification (DBC) were compared. Binary logistic multivariate analysis was performed to investigate independent determinants of severity.
RESULTS:A total of 1655 patients were included; 70 patients (4.2%) died. RAC and DBC were equally superior to AC for describing the clinical course of AP. Although any kind of organ failure was associated with increased morbidity and mortality, persistent organ failure (POF) was the most significant determinant of severity. All local complications were associated with worse outcomes. Infected pancreatic necrosis correlated with high morbidity, but in the presence of POF, it was not associated to higher mortality when compared with sterile necrotizing pancreatitis. Exacerbation of previous comorbidity was associated with increased morbidity and mortality.
CONCLUSION:The RAC and DBC both signify an advance in the description and differentiation of AP patients. Herein, we describe the complications of the disease independently associated to morbidity and mortality. Our findings are valuable not only when designing future studies on AP but also for the improvement of current classifications.
Splanchnic vein thrombosis (SVT) is a well-recognised though little-studied complication in acute pancreatitis (AP). SVT risk factors, its clinical consequences and the role of anticoagulation (AC) ...therapy is scarce.
To evaluate the incidence and natural history of SVT in AP.
Post hoc analysis of a prospective multicentre cohort study involving 23 hospitals in Spain. AP complications were identified by computer tomography, and patients with SVT were re-evaluated after two years.
A total of 1655 patients with AP were included. The overall incidence of SVT was 3.6%. SVT was significantly associated with male gender, younger age and alcoholic aetiology. Every local complication increased SVT incidence, and this risk rose gradually with larger extension and infection of necrosis. These patients had a longer hospital stay and underwent a greater number of invasive treatments, regardless of AP severity. Forty-six patients with SVT were followed up. SVT resolution rate was 54.5% in the AC group and 30.8% in the non-AC group with lower thrombotic complications in the SVT resolution group (83.3% vs 22.7%; p<0.001). No AC-related adverse events occurred.
This study identifies the risk factors and negative clinical impact of SVT in AP. Our results justify future trials to demonstrate the role of AC in this clinical scenario.
In the ageing process, the vascular system undergoes morphological and functional changes that may condition brain functioning; for this reason, the aims of this study were to assess the effect of ...vascular function indirectly measured by ankle-brachial index (ABI) on both cognitive performance at baseline and change in cognitive performance at end of follow-up. We developed a prospective, population-based, cohort study with 1147 participants aged > 65 years obtained from the Toledo Study for Healthy Ageing who had cognitive assessment and measured ABI in the first wave (2006–2009) were selected for the cross-sectional analysis. Those participants who also performed the cognitive assessment in the second wave (2011–2013) were selected for the prospective analysis. Cognitive impairment diagnosis and symptoms and/or history of cardio/neurovascular disease were used as exclusion criteria. Multivariate segmented regression model was used to assess the associations between ABI and cognitive performance in both the cross-sectional and prospective analyses. As ABI score decreased from 1.4, the cross-sectional analysis showed a higher decrease in cognitive performance and the prospective analysis showed a higher degree of worsening in cognitive performance. Our findings suggest that the ABI, a widespread measure of vascular health in primary care, may be a useful tool for predicting cognitive performance and its evolution.
Ageing-related changes in the vascular wall influence the function of different organs; for this reason, we assessed how arterial stiffness measured by carotid-femoral pulse wave velocity (cf-PWV) ...modulates: the basal cognitive performance and the change in cognitive performance over the follow-up time. We developed a prospective, population-based cohort study with 1581 participants aged > 65 years were obtained from the Toledo Study for Healthy Aging. Participants from the second wave (2011-2013) were selected for the cross-sectional analysis. Those who also performed the cognitive assessment in the third wave (2015-2017) were selected for the prospective analysis. Arterial stiffness was evaluated by cf-PWV. Multivariate segmented regression models were used to evaluate the association between cf-PWV scores and basal neuropsychological evaluation scores and change of neuropsychological evaluation scores along follow-up. Cross-sectional analysis showed that as cf-PWV grew within the cf-PWV (5- < 10) category an improvement was observed in 7-min test, free short-term memory, and hole peg test. Furthermore, in the cf-PWV (> 13-18) category a decrease was observed in total short-term memory, free long-term memory, and total long-term memory. Prospective analysis showed a progressive worsening of cognitive function as cf-PWV increases within the cf-PWV (> 13-18) category in 7-min test, object denomination, immediate and short-term memory, and hole peg test, while in the cf-PWV (5- < 10) category, there was observed a decrease in Cumulative Executive Dysfunction Index score and short-term memory. In conclusion, a higher cf-PWV score is associated with worse cognitive performance, and with a worse evolution, reinforcing the need to plan interventions to delay arterial stiffness and its consequences.
INTRODUCTION
This study examined the relationship between blood‐brain‐barrier permeability (BBBp), measured by cerebrospinal fluid/serum albumin ratio (QAlb), and cognitive decline progression in a ...clinical cohort.
METHODS
This prospective observational study included 334 participants from the BIODEGMAR cohort. Cognitive decline progression was defined as an increase in Global Deterioration Scale and/or Clinical Dementia Rating scores. Associations between BBBp, demographics, and clinical factors were explored.
RESULTS
Male sex, diabetes mellitus, and cerebrovascular burden were associated with increased log‐QAlb. Vascular cognitive impairment patients had the highest log‐QAlb levels. Among the 273 participants with valid follow‐up data, 154 (56.4%) showed cognitive decline progression. An 8% increase in the hazard of clinical worsening was observed for each 10% increase in log‐QAlb.
DISCUSSION
These results suggest that increased BBBp in individuals with cognitive decline may contribute to clinical worsening, pointing to potential targeted therapies. QAlb could be a useful biomarker for identifying patients with a worse prognosis.
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