Balance Performance across the Lifespan Assessed by the Leonardo Mechanograph®: A Cross-Sectional Study

Reference values of sway parameters have not been published for the Leonardo mechanograph® so far. The aim of this cross-sectional study was to determine normative values on postural control measured by the force plate Leonardo Mechanograph® and to analyze the influence of age and sex on balance performance. A set of standardized standing positions with eyes opened (Romberg, semi-tandem, tandem, unipedal standing) was carried out. Analysis of covariance (ANCOVA) was used to detect age-and sex-related differences in center of pressure (COP) parameters (path length, velocity, elliptical area, anterior-posterior, and medio-lateral directions). Measurements were available for 570 subjects aged 20–86 years. Statistical analysis showed a high effect of age group on postural control (partial n² between 0.1 and 0.4) with a U-shaped dependency between postural control and age for all area- and path-related COP parameters, with the largest sway in the youngest (aged 20–40) and the oldest age group (aged 60–86). For velocity of COP, a linear deterioration with increasing age was found. Medio-lateral components of COP are likely to indicate the extent of postural control. Significant sex differences were not clearly supported by current findings. Age- and sex-related normative values are a useful resource for diagnostic, research, and training

Longitudinal changes in muscle power compared to muscle strength and mass

Objectives: The study reports longitudinal changes in grip strength, muscle mass and muscle power of lower extremities. The aim is to identify early muscular changes to improve the diagnosis and treatment of sarcopenia. Methods: Grip strength was measured by hand dynamometer, muscle mass by dual-energy X-ray absorptiometry and muscle power by performing a chair rise test and two-leg jumps (2LJP) on the Leonardo Mechanograph®. Longitudinal changes were analysed using paired t-tests by age group and sex. Differences between groups in terms of the annual change were tested by Analysis of Variance and the Dunnett's test. Comparisons between the variables were performed using one sample t-tests. Results: Six-year changes were determined in 318 randomly selected healthy participants aged 20-90 years from Berlin. 2LJP declined significantly earlier in 20-39 years old women (-3.70 W/kg) and men (-5.97 W/kg, both p<0.001). This is an absolute annual decline of -0.46 W/kg in females and -0.75 W/kg in males. In the oldest age group, 2LJP showed the highest absolute annual loss with -0.99 W/kg in women and -0.88 W/kg in men. 2LJP was significantly different compared to all variables of muscle mass and strength (p<0.01). Conclusions: The results underline the importance of assessing muscle power using 2LJP during aging

Age-related collagen turnover of the interstitial matrix and basement membrane: Implications of age- and sex-dependent remodeling of the extracellular matrix

The extracellular matrix (ECM) plays a vital role in maintaining normal tissue function. Collagens are major components of the ECM and there is a tight equilibrium between degradation and formation of these proteins ensuring tissue health and homeostasis. As a consequence of tissue turnover, small collagen fragments are released into the circulation, which act as important biomarkers in the study of certain tissue-related remodeling factors in health and disease. The aim of this study was to establish an age-related collagen turnover profile of the main collagens of the interstitial matrix (type I and III collagen) and basement membrane (type IV collagen) in healthy men and women. By using well-characterized competitive ELISA-assays, we assessed specific fragments of degraded (C1M, C3M, C4M) and formed (PINP, Pro-C3, P4NP7S) type I, III and IV collagen in serum from 617 healthy men and women ranging in ages from 22 to 86. Subjects were divided into 5-year age groups according to their sex and age. Groups were compared using Kruskal-Wallis adjusted for Dunn's multiple comparisons test and Mann-Whitney t-test. Age-specific changes in collagen turnover was most profound for type I collagen. PINP levels decreased in men with advancing age, whereas in women, the level decreased in early adulthood followed by an increase around the age of menopause (age 40-60). Sex-specific changes in type I, III and IV collagen turnover was present at the age around menopause (age 40-60) with women having an increased turnover. In summary, collagen turnover is affected by age and sex with the interstitial matrix and the basement membrane being differently regulated. The observed changes needs to be accounted for when measuring ECM related biomarkers in clinical studies

Association between sarcopenia, physical performance and falls in patients with rheumatoid arthritis: a 1-year prospective study

Background: Patients with rheumatoid arthritis (RA) are at increased risk of falls and fractures. Sarcopenia occurs more frequently in RA patients due to the inflammatory processes. Early diagnosis and prevention programmes are essential to avoid serious complications. The present study aims to identify risk factors for falls related to sarcopenia and physical performance. Methods: In a 1-year prospective study, a total of 289 patients with RA, ages 24-85 years, were followed using quarterly fall diaries to report falls. At the baseline, medical data such as RA disease duration and Disease Activity Score (DAS28(CRP)) were collected. Self-reported disability was assessed using the Health Assessment Questionnaire (HAQ). Appendicular skeletal mass was determined by Dual X-ray-Absorptiometry (DXA). Physical performance was evaluated by handgrip strength, gait speed, chair rise test, Short Physical Performance Battery, and FICSIT-4. Muscle mechanography was measured with the Leonardo Mechanograph (R). Sarcopenia was assessed according to established definitions by the European Working Group on Sarcopenia in Older People (EWGSOP2) and The Foundation for the National Institutes of Health (FNIH). Univariate and multiple logistic regression analysis were used to explore associations with falling. Receiver-operating characteristics (ROC) were performed, and the area under the curve is reported. Results: A total of 238 subjects with RA completed the 1-year follow-up, 48 (20.2%) experienced at least one fall during the observational period. No association was found between sarcopenia and prospective falls. Age (OR = 1.04, CI 1.01-1.07), HAQ (OR = 1.62, 1.1-2.38), and low FICSIT-4 score (OR = 2.38, 1.13-5.0) showed significant associations with falls. Conclusions: In clinical practice, a fall assessment including age, self-reported activities of daily life and a physical performance measure can identify RA patients at risk of falling

Operationalizing multimorbidity and autonomy for health services research in aging populations - the OMAHA study

<p>Abstract</p> <p>Background</p> <p>As part of a Berlin-based research consortium on health in old age, the OMAHA (Operationalizing Multimorbidity and Autonomy for Health Services Research in Aging Populations) study aims to develop a conceptual framework and a set of standardized instruments and indicators for continuous monitoring of multimorbidity and associated health care needs in the population 65 years and older.</p> <p>Methods/Design</p> <p>OMAHA is a longitudinal epidemiological study including a comprehensive assessment at baseline and at 12-month follow-up as well as brief intermediate telephone interviews at 6 and 18 months. In order to evaluate different sampling procedures and modes of data collection, the study is conducted in two different population-based samples of men and women aged 65 years and older. A geographically defined sample was recruited from an age and sex stratified random sample from the register of residents in Berlin-Mitte (Berlin OMAHA study cohort, n = 299) for assessment by face-to-face interview and examination. A larger nationwide sample (German OMAHA study cohort, n = 730) was recruited for assessment by telephone interview among participants in previous German Telephone Health Surveys. In both cohorts, we successfully applied a multi-dimensional set of instruments to assess multimorbidity, functional disability in daily life, autonomy, quality of life (QoL), health care services utilization, personal and social resources as well as socio-demographic and biographical context variables. Response rates considerably varied between the Berlin and German OMAHA study cohorts (22.8% vs. 59.7%), whereas completeness of follow-up at month 12 was comparably high in both cohorts (82.9% vs. 81.2%).</p> <p>Discussion</p> <p>The OMAHA study offers a wide spectrum of data concerning health, functioning, social involvement, psychological well-being, and cognitive capacity in community-dwelling older people in Germany. Results from the study will add to methodological and content-specific discourses on human resources for maintaining quality of life and autonomy throughout old age, even in the face of multiple health complaints.</p

Neuromuscular function and their influence on falls, sarcopenia and impairment in the activities of daily living in older people

Einleitung: Der Alterungsprozess ist charakterisiert durch einen Abbau von Muskelmasse und Muskelfunktion, wobei die Muskelfunktion stärker abnimmt als die Muskelmasse und auch in einem höheren Maße verantwortlich ist für Behinderungen im Alter. Zudem gibt es Hinweise, dass die Muskelleistung mit dem Alter früher und stärker abnimmt als die Maximalkraft. Für die Zukunft gilt es, Messmethoden zu entwickeln, die den funktionellen Abbau frühzeitig und präzise erfassen. In der vorliegenden Arbeit sollen die Messmethoden der Mechanographie und der Ganganalyse im Zusammenhang mit Stürzen, Sarkopenie und Beeinträchtigung in den Aktivitäten des täglichen Lebens untersucht werden. Methodik: Grundlage der vorliegenden Arbeit bilden die Daten aus der populationsbasierten, altersstratifizierten Querschnittsstudie „Muscle_Survey“ mit Männern und Frauen zwischen 20-85 Jahren (n=704) sowie einer Längsschnittstudie „VPHOP“ an 80 postmenopausalen Frauen über 60 Jahren aus Berlin. In der „Muscle_Suvey Studie“ wurden Stürze in den letzten 12 Monaten, Einschränkungen in den Aktivitäten des täglichen Lebens (ADL), die Körperzusammensetzung mittels Dualer Röntgen-Absorptiometrie (DXA) sowie die Muskelfunktion (Mechanographie) erhoben. Mittels Regressionsanalysen wurde der Zusammenhang zwischen der Muskelfunktion mit Stürzen, Sarkopenie und Beeinträchtigung in den Aktivitäten des täglichen Lebens ermittelt. In der „VPHOP Studie“ wurde die Muskelkraft und die Krafteinsatzdifferenzierungsfähigkeit der unteren Extremitäten, die statische Balance (Posturographie) sowie der Gang anhand von drei-dimensionaler Bewegungsanalyse mit einem optischen Messsystem (Vicon) ermittelt. Durch Hauptkomponentenanalyse wurden aussagekräftige Komponenten aus den Muskelfunktionsparametern extrahiert und auf ihre Prädiktionskraft in der Sturzvorhersage untersucht. Ergebnisse: Sowohl Männer als auch Frauen zeigten einen Abbau der Muskelleistung von der dritten zur neunten Lebensdekade von 40-50%. Die Abnahme der Muskelleistung (R2=0.54 bis R2=0.70) lässt sich zu einem höheren Ausmaß durch Alter und Geschlecht erklären als die Abnahme der Muskelkraft (R2=0.18 bis R2=0.36). In der „VPHOP Studie“ zeigte sich ein signifikanter Einfluss auf Stürze im 12 Monats-Follow-up für die drei Hauptkomponenten räumliche Gangparameter (p=0.005), Variabilität zeitlicher Gangparameter links (p=0.093) und Variabilität zeitlicher Gangparameter rechts (p=0.022). ADL-Einschränkung war signifikant korreliert mit allen Mechanographie Tests. Die Muskelleistung im Zweibeinsprung (OR 0.88, 95%-CI 0.79-0.98) und die maximale Geschwindigkeit im Aufstehtest (OR 0.70, 95%-CI 0.53-0.93) blieben signifikante Korrelate für Sarkopenie unabhängig vom Alter in beiden Geschlechtern. Die Muskelleistung im Zweibeinsprung konnte über den Esslinger Fitness Index bei Frauen Stürzer von Nicht-Stürzern differenzieren (OR 0.96, 95%-CI 0.93-0.98). Schlussfolgerungen: Es konnten modifizierbare Einflussgrößen im Zusammenhang mit Stürzen, Sarkopenie und Funktionseinschränkungen im Alltag benannt werden. Die Ergebnisse können dazu beitragen, von einem funktionellen Abbau gefährdete Personen frühzeitig zu identifizieren, um geeignete präventive Maßnahmen ergreifen und auf ihre Wirksamkeit überprüfen zu können.Introduction: The process of aging is characterised by a reduction of muscle mass and function, with muscle function declining more strongly than muscle mass and being responsible to a larger extent for disability in old age. Furthermore, there is evidence that, with age, the decrease of muscle power takes place earlier and more strongly than the decrease of the muscles’ maximum force. For the future, it is therefore necessary to develop measurement techniques that can detect functional decline at an early stage and accurately. For this purpose, the present thesis will examine the measuring techniques of mechanography and gait analysis in the context of falls, sarcopenia and impairment in the activities of daily living (ADL). Methods: The data used for the present thesis were taken, on the one hand, from the population-based age-specific cross-sectional study named “Muscle_Survey”, including men and women aged between 20 and 85 years (n=704), and, on the other hand, from a longitudinal study, i.e. the “VPHOP Study”, including 80 postmenopausal women from Berlin aged over 60 years. The “Muscle_Suvey Study“ recorded falls during the last 12 months, impairment of ADL and measured the body composition using dual-energy X-ray absorptiometry (DXA) as well as muscle function through mechanography. The correlations between muscle function and falls, sarcopenia and impairment of ADL were then determined by means of regression analyses. The “VPHOP Study”, in turn, assessed muscle force, the capacity of differentiated muscle force generation in the lower extremities, static posturography and gait by means of three- dimensional motion analysis using the optical measurement system of Vicon. Through principal component analysis, this thesis identified here the significant components among the muscle function parameters and assessed them as to their forecasting power with respect to falls. Results: Both, men and women, showed a reduction of muscle power of 40 to 50% from the third decade to the ninth. The reduction of muscle power (R2=0.54 to R2=0.70) can therefore be better explained as consequence of age and biological sex than the decrease of muscle force (R2=0.18 to R2=0.36). Based on the data of the “VPHOP Study”, for the three main components, i.e. the spatial gait parameter (p=0.005), the variability of the temporal gait parameter on the left side (p=0.093) and the variability of the temporal gait parameter on the right side (p=0.022), we could observe a significant influence on falls during the 12 months follow-up. Impairment of ADL significantly correlated with all mechanography tests. The muscle power in the single two-legged jump (OR 0.88, 95%-CI 0.79-0.98) and the maximum chair-rise test velocity (OR 0.70, 95%-CI 0.53-0.93), on the other hand, remained significant correlates for sarcopenia in case of both sexes and independently of the patient’s age. By using the Esslinger Fitness Index, and based on the muscle power in the single two-legged jump, we could differentiate between fall patients and non-fallers among women (OR 0.96, 95%-CI 0.93-0.98). Conclusions: The present study could identify modifiable influencing factors in the context of falls, sarcopenia and impairment of ADL. These findings can contribute to the early detection of patients at risk of functional decline in order to be able to adopt the appropriate preventive measures and to review them with respect to their effectiveness

Identification of functional parameters for the classification of older female fallers and prediction of 'first-time' fallers

ISSN:1742-5689ISSN:1742-566

Identifying Fallers Based on Functional Parameters: A Machine Learning Approach

Falls are a leading cause of fracture and mortality in older adults, and hence represent a considerable socioeconomic burden in aging societies. Detection of individuals at a high risk of falls and evaluation of associated factors enable implementation of targeted therapies and timely intervention. The most common indicator for fall prediction is history of falling, but this is a subjective predictor and fails to detect first-time fallers simply because it is absent in such cases. In this study, we used functional variables extracted from multiple functional domains, and implemented several machine learning (ML) methods to classify fallers vs non-fallers retrospectively. We also performed feature importance analysis to provide an insight into the underlying features. Performed within a cross-validation setting, we identified the ML algorithm that best maps individuals’ functional measures to their fall status. In addition, we applied this algorithm for prospective identification of fall risk. In retrospective classification, k-nearest neighbours (KNN) model achieved a sensitivity of 74% and a specificity of 75%. In prospective evaluation, it achieved sensitivity and specificity of 80%. These results reflect the superior capability of machine learning in fallers identification even with a very small dataset

Prevalence of sarcopenia in patients with rheumatoid arthritis using the revised EWGSOP2 and the FNIH definition

Objective In rheumatoid arthritis (RA), chronic inflammation can enhance the development of sarcopenia with a depletion of muscle mass, strength and performance. Currently, a consensus definition for sarcopenia and solid results for the prevalence of sarcopenia in patients with RA are lacking. Methods In this cross-sectional study, 289 patients ≥18 years with RA were recruited. Dual X-ray absorptiometry was performed to measure appendicular lean mass. Assessment of muscle function included grip strength, gait speed and chair rise time. Prevalence of sarcopenia was defined using the updated European Working Group on Sarcopenia in Older People (EWGSOP2) and the Foundation for the National Institutes of Health (FNIH) definition. In addition, the RA study population was compared with existing data of healthy controls (n=280). Results 4.5% of patients (59.4±11.3 years) and 0.4% of controls (62.9±11.9 years) were affected by sarcopenia according to the EWGSOP2 definition. Body weight (OR 0.92, 95% CI 0.86 to 0.97), body mass index (BMI) (OR 0.70, 95% CI 0.57 to 0.87), C reactive protein (CRP) (OR 1.05, 95% CI 1.01 to 1.10), disease duration (OR 1.08, 95% CI 1.02 to 1.36), current medication with glucocorticoids (OR 5.25, 95% CI 2.14 to 24.18), cumulative dose of prednisone equivalent (OR 1.04, 95% CI 1.02 to 1.05) and Health Assessment Questionnaire (HAQ) (OR 2.50, 95% CI 1.27 to 4.86) were associated with sarcopenia in patients with RA. In contrast, the prevalence was 2.8% in patients compared with 0.7% in controls when applying the FNIH definition, and body height (OR 0.75, 95% CI 0.64 to 0.88), BMI (OR 1.20, 95% CI 1.02 to 1.41), CRP (OR 1.06, 95% CI 1.01 to 1.11) and HAQ (OR 2.77, 95% CI 1.17 to 6.59) were associated with sarcopenia. Conclusion Sarcopenia is significantly more common in patients with RA compared with controls using the EWGSOP2 criteria. The FNIH definition revealed sarcopenia in individuals with high BMI and fat mass, regardless of the presence of RA. Trial registration number It was registered at the German Clinical Trials Registry (DRKS) as well as WHO Clinical Trials Registry (ICTRP) (DRKS00011873, registered on 16 March 2017)

Balance and prospective falls in patients with rheumatoid arthritis

Background Postural control is associated with fall risk. Patients with rheumatoid arthritis (RA) have a higher risk to fall than healthy subjects. The objective of this study was to identify associations between variables of postural control with prospective falls in patients with RA. Methods For the baseline, the balance performance of 289 men and women with RA, ages 24–85 years, was evaluated by SPPB, FICSIT-4 and Romberg tests. Postural sway for Romberg, semitandem, tandem and one-leg stands were measured with the Leonardo Mechanograph®. Self-reported disability was assessed using the Health Assessment Questionnaire (HAQ) and the Activity-specific Balance Confidence Scale (ABC-scale). Falls were reported in quarterly reports over a year. Univariate and multiple logistic regression analysis were used to explore any associations with falling. Receiver-operating characteristics were determined, and the area under the curve is reported. Results A total of 238 subjects completed the 1-year follow-up, 48 (20.2%) experienced at least one fall during the observational period. Age (OR = 1.04, CI 1.01–1.07), HAQ (OR = 1.62, 1.1–2.38), FICSIT-4 scoring 0–4 (OR = 2.38, 1.13–5.0), and one-leg standing (OR = 2.14, 1.06–4.31) showed significant associations with falls. With regard to the SPPB and ABC-scale, no statistically significant associations with falls were found. The quartiles containing the worst results of medio-lateral sway of Romberg (OR = 2.63, CI 1.03–6.69), total sway of semitandem (OR = 3.07, CI 1.10–8.57) and tandem (OR = 2.86, CI 1.06–7.69), and area of sway of semitandem (OR = 2.80, CI 1.11–7.08) stands were associated with falls. Conclusions The assessment of a one-leg stand seems to be a good screening tool to discriminate between high and low risk of falls in RA patients in clinical practice. A low FICSIT-4 score and several sway parameters are important predictors of falls