Aims
Changes in heart failure (HF) patients' body composition may be associated with reduced exercise capacity. The aim of the present study was to determine the overlap in wasting syndromes in HF ...(cachexia and sarcopenia) and to compare their functional impact.
Methods and results
We prospectively enrolled 207 ambulatory male patients with clinically stable chronic HF. All patients underwent a standardized protocol examining functional capacity, body composition, and quality of life (QoL). Cachexia was present in 39 (18.8%) of 207 patients, 14 of whom also fulfilled the characteristics of sarcopenia (sarcopenia + cachexia group, 6.7%), whereas 25 did not (cachectic HF group, 12.1%). Sarcopenia without cachexia was present in 30 patients (sarcopenic HF group, 14.4%). A total of 44 patients (21.3%) presented with sarcopenia; however, 138 patients showed no signs of wasting (no wasting group, 66%). Patients with sarcopenia had lower strength and exercise capacity than both the no wasting and the cachectic HF group. Handgrip strength, quadriceps strength, peak oxygen uptake (VO2), distance in the 6‐minute walk test (6MWT), and QoL results were lowest in the sarcopenia + cachexia group vs. the no wasting group (P < 0.05 for all). Likewise, the sarcopenic HF group showed lower handgrip strength, quadriceps strength, 6MWT, peak VO2, and QoL results vs. the no wasting group (P < 0.05 for all).
Conclusion
Losing muscle with or without weight loss appears to have a more pronounced role than weight loss alone with regard to functional capacity and QoL among male patients with chronic HF.
Clinical Trial Registration: ClinicalTrials.gov Identifier NCT01872299.
This systematic review with meta-analyses investigates the impact of resistance training (RT), using meta-regressions, on functional performance in frail and pre-frail adults aged ≥ 65 years to ...determine the key variables of RT. Ten randomized controlled trials involving 1303 participants were analyzed. Five studies assessed habitual walking speed (HWS), three studies evaluated performance in the timed-up-and-go test (TUG), three studies evaluated performance in the Short Physical Performance Battery (SPPB), and three studies assessed performance in the sit-to-stand test (STS). RT alone improved STS time and SPPB scores in frail and pre-frail older adults. RT improved STS performance (Effect Size (ES):− 0.536; 95% CI − 0.874 to − 0.199; p = .002) and led to a 2.261-point increase in SPPB performance (ES:1.682; 95% CI 0.579–2.786; p = .003). At least two weekly training sessions are required to increase SPPB scores, and three sessions seem to optimize the improvements. Higher training volume per exercise and volume per session reduce the gains in SPPB performance. We did not observe any association between different doses of RT and STS time improvements. RT alone positively influenced TUG performance only in community-dwelling older frail and pre-frail adults but not in institutionalized older individuals. RT alone did not improve the HWS compared to the non-active control group.
•Progressive resistance training alone can improve sit-to-stand time and SPPB.•At least two weekly training sessions of RT are needed to increase SPPB scores•The effect of different doses of RT to promote STS improvements is still unclear.•High RT volume per session and per exercise may not be ideal for SPPB changes.•Resistance training alone did not promote differences in walking speed.
evidence on the effectiveness of interventions to prevent frailty is scarce.
to assess the effect of an intervention in preventing frailty progression in pre-frail older people.
a randomised, open ...label, controlled trial with two parallel arms.
community-dwelling pre-frail older people (≥70 years) consulting in primary care.
nutritional assessment (and derivation to a Nutritional Unit for usual care in the event of nutritional risk) and a physical activity programme including aerobic exercise and a set of mixed strengthening, balance and coordination exercises.
patients receiving the usual care.
prevalence of frailty (Fried criteria) at 12 months.
functional capacity (Barthel index), falls and nutritional status (Short-Form Mini Nutritional Assessment) on follow-up at 12 months.
one hundred and seventy-two participants were recruited and randomised (mean age: 78.3 years; mean number of Fried criteria: 1.45). Thirty-nine participants (22.6%) were dropped out during the study. At follow-up, 4.9% of the intervention group and 15.3% of the control group had evolved to frailty, for a crude odds ratio (OR) of 0.29 (95% confidence interval CI: 0.08-1.08; P = 0.052) and an adjusted (by age, gender and number of co-morbidities) OR of 0.19 (95% CI: 0.04-0.95; P = 0.044). Intervention group showed a higher outdoors walking hour per day (0.97 versus 0.73; P = 0.019) but no difference was observed in muscle strength, gait speed or other functional indicators.
an intervention focused on physical exercise and maintaining good nutritional status may be effective in preventing frailty in community-dwelling pre-frail older individuals.
NCT02138968.
The Duke Activity Status Index (DASI) questionnaire might help incorporate self-reported functional capacity into preoperative risk assessment. Nonetheless, prognostically important thresholds in ...DASI scores remain unclear. We conducted a nested cohort analysis of the Measurement of Exercise Tolerance before Surgery (METS) study to characterise the association of preoperative DASI scores with postoperative death or complications.
The analysis included 1546 participants (≥40 yr of age) at an elevated cardiac risk who had inpatient noncardiac surgery. The primary outcome was 30-day death or myocardial injury. The secondary outcomes were 30-day death or myocardial infarction, in-hospital moderate-to-severe complications, and 1 yr death or new disability. Multivariable logistic regression modelling was used to characterise the adjusted association of preoperative DASI scores with outcomes.
The DASI score had non-linear associations with outcomes. Self-reported functional capacity better than a DASI score of 34 was associated with reduced odds of 30-day death or myocardial injury (odds ratio: 0.97 per 1 point increase above 34; 95% confidence interval CI: 0.96–0.99) and 1 yr death or new disability (odds ratio: 0.96 per 1 point increase above 34; 95% CI: 0.92–0.99). Self-reported functional capacity worse than a DASI score of 34 was associated with increased odds of 30-day death or myocardial infarction (odds ratio: 1.05 per 1 point decrease below 34; 95% CI: 1.00–1.09), and moderate-to-severe complications (odds ratio: 1.03 per 1 point decrease below 34; 95% CI: 1.01–1.05).
A DASI score of 34 represents a threshold for identifying patients at risk for myocardial injury, myocardial infarction, moderate-to-severe complications, and new disability.
To determine the impact of exercise on functional capacity, measured through the “Six minutes walking test” (6MWT) in patients with advanced cancer stage.
Systematic research on PubMed, Cochrane ...Library, and SportDiscus was conducted. Randomized controlled trials were eligible if they examined the effect of exercise on 6MWT.
Overall, a total of ten trials were included in the primary analysis. Compared to the controls, the exercise intervention was associated with an increase in functional capacity (+20.86 m; CI: −5.90 to 47.72, p = 0.12) although not reaching the statistical significance. Sensitivity analysis revealed an improvement for studies proposing a supervised exercise intervention towards the statistical significance. Few adverse events were associated with exercise training, and the median withdrawals rate was 17%.
Exercise may have a beneficial role on functional capacity in patients with advanced cancer, especially if supervised.
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Background & Aim: Aging leads to bodily changes and impairment of functional capacity in older adults. The objective was to analyze the association between socio-demographic and health data, ...cognitive impairment, and risk of sarcopenia with functional capacity in older adults enrolled in the Family Health Strategies in the rural area of the municipality of Picos, Piauí, Brazil. Methods & Materials: This is a quantitative and cross-sectional study that was developed with 320 older adults attending the Family Health Strategies located in the rural area of Picos, Piauí, Brazil. The participants were people 60 years old, registered in the Family Health Strategies, and living in a rural area. Data was collected in the older adults’ homes using the following instruments: Demographic profile, Self-reported illnesses, Mini-Mental State Examination, Barthel Index, Lawton and Brody Scale, and SARC-F. Results: It was found that 70% had cognitive impairment, 53.8% were at risk of sarcopenia, with a mean of 93.72 (SD=11.84) points for basic activities daily living, and 77.8% with partial dependence for instrumental activities daily living with a mean of 16.79 (SD=3.79) points. In the multivariate multiple regression, it was identified that there was an association between Basic Activities of Daily Living and Instrumental Activities of Daily Living with age (p<0.001), number of children (p=0,025), education (p=0.003), monthly income (p=0.018), number of diseases (p<0.001), sarcopenia (p<0.001) and cognitive status (p<0.001). Conclusion: A high prevalence of functional disability was identified in elderly people living in the rural area of Picos, Piauí, Brazil. Therefore, it is important to pay attention to factors associated with dependence on daily activities.
Psyllium fibre has known health benefits, which are highly related to its gelling properties, so it is important to know the functional properties and its gelling capacity to its possible ...incorporation as a new source of DF in foods. Therefore, the purpose of this research was to evaluate these properties of two Psyllium fibres. Physicochemical (particle size distribution, pH, water content, water activity, hygroscopicity and bulk density and porosity), hydration (water holding, water retention and swelling capacity, fat absorption capacity and solubility), and nutritional properties (mineral content, total phenolics compounds and antioxidant capacity) of dietary fibre (DF) samples were recorded. Moreover, physicochemical (water content, pH and colour) and mechanical properties (back extrusion test, rheological measurement and texture profile analysis) of gel samples were performed before and after heat treatment (20 min at 65 °C). The hydration properties of Plantago Husk (PH) were higher than those in Plantago Powder (PP), but in functional terms, high values of phenols and antioxidant activity were found in PP. However, both samples displayed similar gelling properties. As a result of the rheological and textural analysis, both fibres showed good gelling properties at both high (65 °C) and cool (5 °C) temperatures, at concentrations 4%–7%. Moreover, the results indicate that PH and PP have suitable characteristics to be functional ingredients, which can help to avoid possible negative effects on food sensory and structural characteristics.
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•Physicochemical, hydration and nutritional properties of Psyllium dietary fibres.•Hydration properties of Plantago Husk were greater.•Antioxidant capacity and phenols content were higher in Plantago Powder.•Formation of hydrogels with Psyllium fibres.•Plantago Husk and Plantago Powder showed gelling properties at high and cool temperatures.
Diabetic nephropathy is a growing public health challenge with implications on health. Renal function decline impacts the functional ability and overall health and well-being of individuals with ...diabetic nephropathy due to development of several renal manifestations. The objective of the study was to determine the effect of an exercise-based rehabilitation program on functional capacity and renal function among individuals with type 2 diabetic nephropathy.
A total of 283 individuals were screened and 60 eligible participants aged 45-70 years with diabetic nephropathy were randomly allocated (n = 30 each) to the intervention group (IG) and control group (CG), respectively. The study outcome measures comprised of functional capacity (6-min walk test) and renal function assessed at baseline, 12th week and 24th week. Participants allocated to IG received 12 weeks of exercise based rehabilitation (comprising of supervised + home-based exercises) along with standard care and followed-up till 24th week.
The repeated measures ANOVA with Greenhouse-Geisser correction indicated significant timepoint*group interaction effect for 6-min walk distance F
= 619, p < 0.001, serum creatinine F
= 174.8, p < 0.001, estimated glomerular filtration rate F
= 105.2, p < 0.001, serum urea F
= 261.4, p < 0.001 and urine protein F
= 4.58, p < 0.328.
The study found that exercise based rehabilitation improved both functional capacity and renal function among individuals with type 2 diabetic nephropathy.
Objective: This study compared the differences in functionality and depression between younger and older patients with chronic low back pain (CLBP). Materials and Methods: This multi-center ...cross-sectional survey enrolled subjects with CLBP who visited physical medicine and rehabilitation clinics in seven different regions of Turkey. Sociodemographic data were collected via questionnaires. Functional status was evaluated with Roland-Morris Disability index (RMDI), and psychological health was evaluated with Beck Depression inventory (BDI). Results: The sample included 106 younger mean age: 24.3 (range: 18-30) years and 104 older mean age: 70.5 (range: 65-108) years subjects. No significant difference was found in the gender distribution between the younger (38 males, 68 females) and older (38 males, 66 females) groups (p=0.917). The BDI was 11.90±10.6 in the younger subjects and 16.17±10.72 in the older subjects (p=0.002), whereas the mean RMDIs were 10.31±6.36 and 16.04±5.36, respectively (p=0.001). Conclusion: The loss of functional capacity and depression resulting from CLBP are serious threats to public health and are predictive of chronic disability. The development of social programs that address risk factors will reduce the risk of CLBP, improve quality of life, reduce workforce losses and contribute significantly to public health.
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