Are Older Adults Who Volunteer to Participate in an Exercise Study Fitter and Healthier Than Nonvolunteers? The Participation Bias of the Study population

Participation bias in exercise studies is poorly understood among older adults. This study was aimed at looking into whether older persons who volunteer to participate in an exercise study differ from nonvolunteers. Methods: A self-reported questionnaire on physical activity and general health was mailed out to 1000 persons, aged 60 or over, who were covered by the medical insurance of the French National Education System. Among them, 535 answered it and sent it back. Two hundred and thirty-three persons (age 69.7 +/- 7.6, 65.7% women) said they would volunteer to participate in an exercise study and 270 (age 71.7 +/- 8.8, 62.2% women) did not. Results: Volunteers were younger and more educated than nonvolunteers, but they did not differ in sex. They had less physical function decline and higher volumes of physical activity than nonvolunteers. Compared with volunteers, nonvolunteers had a worse self-reported health and suffered more frequently from chronic pain. Multiple logistic regressions showed that good self-reported health, absence of chronic pain, and lower levels of physical function decline were associated with volunteering to participate in an exercise study. Conclusions: Volunteers were fitter and healthier than nonvolunteers. Therefore, caution must be taken when generalizing the results of exercise intervention studies

Le processus incapacitant au cours du vieillissement : rôle de l’exercice/activité physique

Le vieillissement est un phénomène d’importance croissante dans les sociétés actuelles. Bien que le rôle exercé par la pratique d’exercice/activité physique sur le maintien d’une capacité physique fonctionnelle optimale durant le vieillissement soit bien établi, l’inactivité physique est encore un comportement largement présent chez les personnes âgées, ce qui facilite le développement du processus incapacitant. Le but de cette revue de synthèse est d’exposer la chaîne de déclins physiologiques et fonctionnels au cours du vieillissement. Cette étude vise aussi à élucider le rôle exercé par la pratique d’exercice/activité physique afin d’empêcher ou retarder le début de tels déclins, et de renverser ou diminuer leur impact négatif sur des individus qui vieillissent. Ce travail explore l’influence des principales composantes du processus incapacitant (fragilité, limitation physique fonctionnelle, dépendance), et de la pratique d’exercice/activité physique sur la capacité physique fonctionnelle. Concernant le rapport « exercice/activité physique – processus incapacitant », certaines incohérences apparaissent parmi les études, ce qui réduit la possibilité de comparaison entre elles, et limite les conclusions. La définition du concept de fragilité, ainsi que la façon de mesurer les variables exercice/activité physique et fragilité constituent une des principales incohérences parmi ces études. Malgré cela, il ressort de ces études que la pratique régulière d’exercice/activité physique réduit des déclins liés à l’âge, tant sur le plan physiologique que sur celui de la capacité physique fonctionnelle. La pratique régulière d’exercice/activité physique contribue ainsi au maintien de l’indépendance des personnes âgées, à travers une minimisation des effets négatifs du processus incapacitant.Aging is a phenomenon of increased importance in contemporaneous societies. Although it is well established that physical exercise/activity contributes to maintain functional fitness at optimal levels, physical inactivity is a largely prevalent behaviour among elderly people, thus facilitating the disablement process. The purpose of this review is to study physiological and functional declines during aging. This article also tries to clarify the role played by physical exercise/activity in avoiding or delaying those declines, and in reverting or diminishing their negative impacts on older adults’ health. The influences of both disablement process main components (frailty, disability, and dependence) and of physical exercise/activity on functional fitness are examined. Concerning the relationships between physical exercise/activity and disablement process, some inconsistencies arise among articles, making difficult to compare them and to draw conclusions. The definitions of frailty, as well as the ways to measure physical exercise/activity, constitute the main inconsistencies among studies. However, most of the researches show that a regular practice of physical exercise/activity decreases the age-related declines in both physiological status and functional fitness. Then, exercising regularly can contribute to maintain independence in older adults by reducing the negative effects of the disablement process

Assessment of plasma amyloid-β42/40 and cognitive decline among community-dwelling older adults

Importance: Plasma measurement of amyloid-β (Aβ) peptides has been associated with cognitive function, but evidence of its ability to identify cognitive decline is still scarce. Objective: To investigate the associations between plasma Aβ42/40 and cognitive decline over time among community-dwelling older adults with subjective memory concerns. Design, Setting, and Participants: This multicenter cohort study used data from volunteers in the 5-year study Multidomain Alzheimer Preventive Trial (MAPT). Participants were aged 70 years or older and observed for a median (interquartile range) of 3.9 (2.0-4.0) years. Recruitment of participants started in May 2008 and ended in February 2011. Follow-up ended in April 2016. Data analysis was conducted from April to October 2020. Exposure: Plasma Aβ42 and Aβ40 were measured at 12 months for 448 participants (92.8%) and at 24 months for the rest. The moment of Aβ assessment was defined as the baseline for this study. Main Outcomes and Measures: Cognitive function was assessed at 12, 24, 36, 48, and 60 months by a composite cognitive score based on 4 tests; Mini Mental State Examination (MMSE); Clinical Dementia Rating, sum of boxes; and Alzheimer Disease Cooperative Study-Activities of Daily Living. Mixed-effect linear regressions were performed. Results: A total of 483 participants (median [IQR] age, 76.0 [73.0-80.0]; 286 [59.2%] women) were analyzed. Of them, 161 (33.3%) were classified as low plasma Aβ42/40 (≤0.107). After adjusting for age, sex, education, body mass index, Geriatric Depression Scale score, apolipoprotein E ε4 genotype, and MAPT intervention groups, low plasma Aβ42/40 was associated with more pronounced decline in composite cognitive score (adjusted between-group mean difference: -0.20, 95% CI, -0.34 to -0.07; P = .004) and decline in MMSE score (adjusted between-group mean difference: -0.59; 95% CI, -1.07 to -0.11; P = .02) during the follow-up period compared with the group with an Aβ42/40 ratio greater than 0.107. Conclusions and Relevance: In this study, low plasma Aβ42/40 was associated with more pronounced decline in cognitive function (measured by multiple outcomes) over time. Findings suggest that plasma Aβ42/40 may be used to identify people at risk of cognitive decline, being an alternative to more complex and expensive measures, such as positron emission tomography imaging or cerebrospinal fluid measurement

Lack of energy is associated with malnutrition in nursing home residents: Results from the INCUR study

BackgroundLack of energy is a symptom frequently complained by older people, leading to the inability to continue functioning at the expected level of activity. This study aimed to investigate whether nutritional status was associated with lack of energy in nursing home (NH) residents.MethodsThis was a cross-sectional study. A total of 570 NH residents (72.1% women) in 13 French NHs from the Incidence of pNeumonia and related ConseqUences in nursing home Residents study cohort were included in the study. Lack of energy was measured by the question "Did you feel full of energy during the past week?" from the geriatric depression scale. Nutritional status was evaluated according to Mini Nutritional Assessment Short-Form (MNA-SF). Unadjusted and adjusted logistic regression models were performed to test the association of nutritional status with lack of energy.ResultsThe mean age of participants was 86.5 (SD 7.5) years. A total of 246 NH residents (43.2%) reported a lack of energy. Overall, 71 (12.5%) residents were malnourished and 323 (56.7%) residents were at risk of malnutrition. Malnutrition was significantly associated with lack of energy (OR = 3.42, 95% CI = 1.92-6.08, P ConclusionsLack of energy and malnutrition were closely associated. The reporting of lack of energy should lead to a comprehensive assessment of the aging individual (as happening for malnutrition) in order to preventively/promptly act on potentially reversible causes

Effects of a 12-week Vivifrail exercise program on intrinsic capacity among frail cognitively impaired community-dwelling older adults: secondary analysis of a multicentre randomised clinical trial

Introduction: The World Health Organisation recently defined the construct of intrinsic capacity (IC), a function-based marker of older adult’s health encompassing all mental and physical capacities of the individual. Multicomponent physical exercise (MCE) is a potential intervention capable to maintain/increase IC at older age; however, evidence is scarce on the effects of MCE on IC in cognitively impaired pre-frail/frail older adults. Methods: Secondary analyses of a randomised clinical trial. One hundred and eighty-eight older outpatients (age = 84.06 ± 4.77, 70.2% women) presenting with pre-frailty/frailty (according to Fried Criteria) and mild cognitive impairment (MCI)/mild dementia were recruited in the Geriatric clinics of three tertiary hospitals in Spain. Subjects were randomised to participate in the 12-week home-based individualised Vivifrail MCE or usual care. An IC index was created based on the z-score of the locomotion (Short Physical Performance Battery), cognitive (Montreal Cognitive Assessment), psychology (15-item Geriatric Depression Scale Yesavage) and vitality (handgrip strength) domains. Results: After the 3-month intervention, linear mixed models showed significant between-group differences in the evolution of the IC composite score (β=0.48; 95% confidence interval [CI] = 0.24, 0.74; P < 0.001), IC Locomotion (β = 0.42; 95% CI = 0.10, 0.74; P < 0.001), IC Cognition (β = 0.45; 95% CI = 0.03, 0.87; P < 0.05) and IC Vitality domains (β = 0.50; 95% CI = 0.25, 0.74 at 3-month) favouring the MCE group. Conclusions: The 12-week Vivifrail multicomponent exercise program is an effective strategy to enhance IC, especially in terms of locomotion, cognition and vitality IC domains in community-dwelling older adults with pre-frailty/frailty and MCI/mild dementia, compared to usual care.This study has been funded by a Gobierno de Navarra project grant and FEDER Funds (426/2016,del 30 September28/16)

Cross-sectional Associations of Fatigue with Cerebral &#946;-Amyloid in Older Adults at Risk of Dementia

Fatigue is a common symptom in the elderly and has also been associated with impaired cognition in older adults. Hence, we sought to explore the cross-sectional relationship between fatigue and cerebral \u3b2-amyloid (A\u3b2) in 269 elderly individuals reporting subjective memory complaints from the Multidomain Alzheimer Preventive Trial. Standard uptake value ratios (SUVRs) were generated by [18F] florbetapir positron emission tomography (PET) using the cerebellum as a reference. Cortical-to-cerebellar SUVRs (cortical-SUVRs) were obtained using the mean signal from the frontal cortex, temporal cortex, parietal cortex, precuneus, anterior cingulate, and posterior cingulate. Other brain regions independently assessed were the anterior cingulate, anterior putamen, caudate, hippocampus, medial orbitofrontal cortex, occipital cortex, parietal cortex, pons, posterior cingulate, posterior putamen, precuneus, semioval center, and temporal cortex. Fatigue was defined according to two questions retrieved from the Center for Epidemiological Studies-Depression scale. Chronic fatigue was defined as meeting fatigue criteria at two consecutive clinical visits 6 months apart between study baseline and 1 year (visits were performed at baseline, 6 months and 1 year then annually). Cross-sectional associations between fatigue variables and cerebral A\u3b2 were explored using fully adjusted multiple linear regression models. We found no statistically significant cross-sectional associations between fatigue assessed at the clinical visit closest to PET and A\u3b2 in any brain region. Similarly, chronic fatigue was not significantly associated with A\u3b2 load. Sensitivity analysis in subjects with a Clinical Dementia Rating of 0.5 showed that fatigue reported at the clinical visit closest to PET was, however, weakly associated with increased A\u3b2 in the hippocampus (B-coefficient: 0.07, 95% CI: 0.01, 0.12, p\u2009=\u20090.016). These preliminary results suggest that fatigue might be associated with A\u3b2 in brain regions associated with Alzheimer's disease in subjects in the early stages of disease

Participation bias in postal surveys among older adults: The role played by self-reported health, physical functional decline and frailty

International audiencePostal survey is a simple and efficient way to collect information in large study samples. The purpose of this study was to find out differences between older adults who responded to a postal survey on health outcomes and those who did not, and to examine the importance of frailty, physical functional decline and poor self-reported health in determining non-response. We mailed out a questionnaire on general health twice at a year's interval to 1000 individuals ≥60 years, and members of the medical insurance scheme of the French national education system. At Year1, 535 persons responded to the questionnaire (65% women, 70.98.4 years). A year later (Year2), we obtained 384 responses (63.3% women, 70.57.8 years). Compared to respondents, non-respondents at Year2 were more frequently categorized as frail, reported more often to be in bad health, and had more physical functional declines. Frailty, physical functional decline and poor self-reported health increased the likelihood of not responding to Year2 questionnaire, with poor self-reported health weakening the association of physical functional decline and non-response. Respondents of this postal survey are fitter and healthier than non-respondents. This participation bias precludes the generalization of postal surveys results

One Operational Definition by Population: The Need for Local Evaluations of Frailty

Frailty is a health problem that increases the probability of developing adverse health outcomes in the elderly. A frequently used way to operationalize frailty is the construction of a frailty index, which is built from the addition of several health deficits that describe biological aging. However, there is no consensus about the number of health deficits for building a frailty index and about which deficits must be chosen. This lack of a standardized frailty index is assumed to be an obstacle for the advancement of research on frailty. The focus of the present article is to propose a theoretically plausible alternative way of operationalizing frailty by means of frailty indexes composed of deficits selected at a local level. These deficits would therefore be different for each given population. This "anthropological approach" is on the opposite side from current trends in frailty research, which is characterized by the search for a standardized operational definition of frailty. The anthropological approach would generate more reliable data by taking into account the specificity of the population to be studied for selecting frailty deficits. In this approach, emotions, motives, and beliefs are as important to determine individuals' health vulnerability as chronic diseases and physical function. Physiological anthropologists are well positioned to contribute to research on frailty by carrying out studies on the selection of the best deficits to operationalize frailty in different populations, with different socio-cultural determinants of health, and living in different environmental life spaces

Atualidades sobre fragilidade no idoso e exercicio fisico Current issues about frailty in the elderly and phycisal exercise

Frailty in the elderly is associated with several negative health outcomes in this population. However, lack of consensus among experts with regard to its etiology, definition, and operational features makes difficult the progress in research area and its clinical implications. Moreover, one of the most frequently feature associated with frailty is physical inactivity. In despite of this, influence of physical exercise on frailty development and evolution is unknown. The purpose of this review study is to discuss 1) the main points of debate regarding etiology and definition of frailty, the criteria of classification for frail elders, as well as 2) the role played by physical exercise in this debate. By several kinds of search and selection, articles in French, Spanish, Portuguese, and English were selected. In general, they were published between 2002 and January 2008. Based on currently scientific evidence, frailty advances (provided by genetical, physiological and nutritional areas, as well as by researches on functional limitations/disability and co-morbidities) and obstacles for research and clinical areas are exposed anddiscussed. The influence of physical exercise in preventing or delaying frailty, as well as in stopping or reversingits negative effects, was not confirmed, specially because research absence in this field.A fragilidade no idoso está associada a inúmeras repercussões negativas na saúde dessa população. Entretanto, a falta de consenso entre os gerontólogos com relação à sua etiologia, definição e operacionalização dificulta tanto a evolução das pesquisas quanto sua utilização clínica. Uma das características mais freqüentemente associadas à fragilidade é a inatividade física. Apesar disso, pouco se conhece sobre a importância do exercício físico em sua dinâmica de instalação e progressão. Esta revisão de literatura se propõe a 1) expor os pontos dedebate concernentes à etiologia, definição e operacionalização (classificação de idoso frágil) de fragilidade, bem como 2) a discutir o papel do exercício físico neste debate. Foram selecionadas publicações em francês, espanhol, português e inglês, realizadas, principalmente, entre janeiro de 2002 e janeiro de 2008, utilizando-se diversos modos de busca e seleção. Baseados na evidência atual, os avanços já estabelecidos (com a ajuda da genética, da fisiologia, da nutrição, bem como a partir de estudos sobre as limitações físicas funcionais e comorbidades) e os obstáculos ainda existentes para o estudo e a utilização clínica do conceito de fragilidade são expostos e discutidos. A relevância da prática de exercícios físicos a fim de prevenir ou retardar o desenvolvimento da fragilidade, bem como conter ou reverter seus efeitos deletérios, não pôde ser confirmada devido a uma quase completa ausência de estudos nessa área