Associação entre estágios da sarcopenia, risco de quedas, equilíbrio estático e Incidência de quedas em mulheres idosas

Tese (doutorado)—Universidade de Brasília, Faculdade de Educação Física, Programa de Pós-Graduação em Educação Física, 2018.Objetivo: Os objetivos do presente estudo foram: a) investigar a associação entre os estágios da sarcopenia, equilíbrio estático, medo de cair e risco de quedas em mulheres idosas; e b) investigar a associação entre os estágios da sarcopenia e a incidência de quedas no período de 18 meses em mulheres idosas. Métodos: 196 mulheres (68,6±6,5 anos) foram submetidas a avaliações de composição corporal (DEXA), força muscular e funcionalidade (TUG). Os estágios da sarcopenia foram classificados de acordo com o EWGSOP. A oscilação do centro de pressão (CoP), o risco e o medo de cair foram avaliados por meio de plataforma de força, QuickScreen e escala de eficácia de quedas, respectivamente. As voluntárias foram acompanhadas durante 18 meses por ligações telefônicas. Modelos de ANOVA e chi-quadrado foram utilizados para comparar os grupos. Regressões de Cox foram aplicadas para calcular as taxas de risco de quedas. Resultados: Os sujeitos sarcopênicos grave apresentaram maior risco de queda quando comparado aos demais estágios (P<0,01). Considerando a oscilação do CoP, tanto a velocidade quanto a amplitude mediolateral foram significativamente maiores para sarcopenia grave quando comparado ao grupo de referência e pré-sarcopenia (P<0,05). O medo de cair foi maior em todos os estágios da sarcopenia quando comparados aos indivíduos não sarcopênicos (P<0,05). A incidência de quedas foi 17,7%, 15,4%, 40,7% e 72% para o grupos de referência, pré- sarcopenia, sarcopenia e sarcopenia grave, respectivamente (X 2 =30.637; P<0.001). A sarcopenia grave apresentou maior taxa de risco de quedas (hazard ratio: 4.956; 95% CI: 2.259-10.876). Conclusão: A sarcopenia afeta negativamente o equilíbrio, o risco e o medo de cair em mulheres idosas. Além disso, a gravidade da sarcopenia associou-se com a incidência de quedas. Este estudo fornece evidências de que a gravidade da sarcopenia está associada ao equilíbrio reduzido e impõe um maior risco quedas em mulheres idosas.Objective: The aims of the present study were a) to investigate the association between stages of sarcopenia, static balance, fear of falling, and risk of falls in older women; and b) to investigate the association between the stages of sarcopenia and incidence of falls in older women. Methods: 196 women (68.6±6.5 years) underwent body composition (DXA), muscle strength, and functional (TUG) assessments. Stages of sarcopenia were classified according to EWGSOP. Center of pressure (CoP) sway, risk and fear of falling were assessed through force platform, QuickScreen, and Falls Efficacy Scale, respectively. Volunteers were tracked by phone calls after a follow up period of 18 months. ANOVA models and chi-squared were used to compare groups. Cox regressions were applied to calculate the hazard ratios of falls events. Results: Severe sarcopenic subjects presented higher risk of falling when compared to the other stages (P<0.01). Regarding CoP sway, both mean speed and mediolateral range were significantly higher in severe sarcopenia when compared to both nonsarcopenia and presarcopenia (P<0.05). Fear of falling was higher in all sarcopenia stages when compared to nonsarcopenic individuals (P<0.05). The incidence of falls were 17.7%, 15,4%, 40,7%, and 72% for nonsarcopenia, pre-sarcopenia, sarcopenia, and severe sarcopenia, respectively (X2 =30.637; P<0.001). Severity of sarcopenia showed higher risk of falls when compared to nonsarcopenia (hazard ratio: 4.956; 95% CI: 2.259-10.876). Conclusion: Sarcopenia negatively affects balance, risk and fear of falling in older women. Moreover, severity of sarcopenia was associated with incidence of falls. This study provides evidence that severity of sarcopenia is further associated to reduced balance and imposes an even greater risk and incidence of falls in the older women

Comparação entre índices da adiposidade corporal na predição de fatores de risco cardiometabólico e na funcionalidade de mulheres idosas

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Educação Física, Programa de Mestrado em Educação Física, 2015.OBJETIVO: Comparar os principais índices da adiposidade corporal na predição de fatores de risco cardiometabólico e na funcionalidade de mulheres idosas. MÉTODOS: Uma amostra representativa de mulheres idosas residentes no Distrito Federal (n=149; 67.17±6.12 anos) foi submetida a avaliação da composição corporal por meio do DEXA e outros 5 índices antropométricos (circunferência de cintura - CC, relação cintura estatura - RCE, índice de massa corporal - IMC, índice de adiposidade corporal - IAC e índice de conicidade - IC). A pressão arterial foi medida por método oscilométrico e análise sanguínea foi conduzida para perfil glicêmico, perfil lipídico e proteína C-reativa. A classificação da síndrome metabólica (SM) adotada obedeceu aos critérios do NCEP-ATP III. Os testes funcionais de levantar e sentar, agilidade e caminhada de 6 minutos foram conduzidos em subgrupo aleatorizado (n=87). A correlação de Pearson foi utilizada para identificar o relacionamento entre as variáveis e o teste t para amostras independentes para comparar os sujeitos classificados com e sem os desfechos de SM e de incapacidade funcional. Definiu-se pontos de corte específicos para cada índice de adiposidade a partir da curva ROC e o odds ratio foi calculado para os desfechos de desordem metabólica e funcionalidade baixa. RESULTADOS: Exceto para colesterol total e LDL, as variáveis de risco cardiometabólico apresentaram correlação significativa com pelo menos um dos índices da adiposidade. SM e capacidade funcional baixa apresentaram prevalência de 29.5% e de 36.8%, respectivamente. O grupo classificado com o desfecho de SM apresentou condição cardiometabólica inferior em comparação ao grupo de referência, com exceção de colesterol total e LDL. Os testes de Levantar e Sentar, Caminhada de 6 minutos e Agilidade apresentaram associação mais consistente com CC (r=-0.345; p<0.01), RCE (r=-0.417; p<0.01) e IAC (r=0.296; p<0.01), respectivamente. Na comparação entre as curvas ROC, a CC apresentou-se maior que %G (p<0.001), IAC (p<0.001), IC (p<0.02), IMC (p<0.04). O odds ratio para os desfechos de SM e incapacidade funcional foi maior para CC (OR=18.62; IC: 6.71-51.69) e RCE (OR=7.75; IC:0.95-63.17), respectivamente. CONCLUSÃO: Com base nos resultados apresentados, conclui-se que os índices da adiposidade que consideraram a gordura abdominal em seus cálculos apresentaram maior poder discriminatório e relacionamento mais consistente com os fatores de risco cardiometabólico e com a funcionalidade em amostra composta por mulheres idosas.OBJECTIVE: To compare the main fatness indexes to predict cardiometabolic risk factors and functionality of older women. METHODS: A representative sample of older women from Federal District (n=149; 67.17±6.12 years) underwent to body composition assessment by DXA and other 5 anthropometric indexes (Waist Circumference – WC, Waist-to-Height Ratio – WHtR, Body Mass Index – BMI, Body Adiposity Index - BAI, and Conicity Index – CI). Blood pressure was evaluated by oscillometric method and blood sample was collected to glycemic profile, lipid profile, and C-reactive protein. Metabolic Syndrome (MetS) classification criteria was NCEP-ATP III. 30-s chair stand, 8-foot up-and-go, and 6-minute walk were performed in a randomized subsample (n=87). Pearson´s correlation was applied to identify the relationship between variables and the t test to independent samples to compare the subjects classified with and without MetS and disability. Odds ratio was calculated for outcomes of metabolic disorders and low functionality. RESULTS: Except for total cholesterol and LDL-cholesterol, cardiometabolic risk variables showed significant correlation with at least one of fatness indexes studied. MetS and low functional capacity prevalence was set 29.5% and 36.8%, respectively. The MetS group presented inferior cardiometabolic condition when compared with the reference group, except to total cholesterol and LDL-cholesterol. 30-s chair stand, 6-minute walk, and 8-foot up-and-go showed better consistent association with WC (r=-0.345; p<0.01), WHtR (r=-0.417; p<0.01), and BAI (r=0.296; p<0.01), respectively. In compare among ROC curves, the WC presented larger than fatness (p<0.001), BAI (p<0.001), CI (p<0.02), BMI (p<0.04). Odds ratio to MetS and disability outcomes were higher to WC (OR=18.62; CI: 6.71-51.69) and WHtR (OR=7.75; CI:0.95-63.17), respectively. CONCLUSION: Based on the presented results, it was concluded that the indexes of fatness which considered abdominal fat in its calculation had higher discriminatory power and more consistent relationship with cardiometabolic risk factors and with functionality in older women

Força, qualidade muscular e marcadores de risco cardiometabólico em mulheres idosas

O processo de envelhecimento está associado a um declínio nas funções fisiológicas, refletindo em reduções na qualidade muscular, bem como em alterações de marcadores de risco cardiometabólico. Nesse sentido, o objetivo do estudo foi verificar a associação entre qualidade muscular e marcadores de risco cardiometabólico em mulheres idosas. Trinta mulheres idosas (66,13±5,26 anos, 67,33±12,45 kg, 1,54±0,07 m, 28,20±4,72 IMC) foram submetidas à avaliação da espessura e força musculares do quadríceps, e à análise sanguínea de marcadores de risco cardiometabólico (glicemia, insulina basal, proteína C-reativa, colesterol total, HDL-colesterol, LDL-colesterol, VLDL-colesterol, triglicerídeos, e índice HOMA-IR). Não foram encontradas correlações significativas entre os fenótipos musculares e os marcadores de risco cardiometabólico estudados, mesmo com controle para fatores de confusão. A presente pesquisa indica não haver correlação entre força e qualidade muscular com os marcadores de risco cardiometabólico estudados.The aging process is associated with a decline in physiological functions, including a reduction in muscle quality, as well as changes in cardiometabolic risk factors. Thus, the aim of this study was to verify if a correlation exists between muscle strength and quality and cardiometabolic risk markers in older women. Thirty older women (66.13±5.26 years, 67.33±12.45 kg, 1.54±0.07 m, body mass index: 28.20±4.72) were submitted to the evaluation of muscle thickness and strength and blood analysis of cardiometabolic risk markers (glucose, basal insulin, C-reactive protein, total cholesterol, HDL-cholesterol, LDL-cholesterol, VLDL-cholesterol, triglycerides, and HOMA-IR). No significant correlations were found between muscle phenotypes and markers of cardiometabolic risk, even after adjustment for confounding factors. The present study indicates that muscle strength or quality is not correlated with markers of cardiometabolic risk

The beginning of success: Performance trends and cut-off values for junior and the U23 triathlon categories

Background This study sought to determine cut-off values for each triathlon discipline to achieve podium in Junior (short distance; 750 m swim, 20 km cycle and 5 km run) and U23 (standard/Olympic distance; 1.5 km swim, 40 km cycle and 10 km run) triathlon events. Additionally, we aimed to investigate which discipline has the largest relationship with overall Junior and U23 triathlon performance, and the effect of sex and time in performance trends. Methods We included all data from Junior and U23 official races (International Triathlon Federation; ITU) of Junior (n = 3,314 finishes) and U23 (n = 5,092 finishes) categories held from 1999 to 2018. Results Men were significantly faster than women in both Junior (11.13%) and U23 (12.28%) categories. Swimming and cycling times were faster in 2009-2018 than in the 1999-2008 decade for men (3.36%; 6.49%), women junior (6.50%; 7.09%), men (0.15%; 3.46%) and women U23 (1.61%; 3.31%) respectively. Cycling was the discipline with the greatest influence on overall triathlon performance in Junior and U23 categories, regardless of sex or rank position. The cut-off values for the Junior category were (men/women): swimming, 9.2/9.4 min; cycling, 31.9/38.2 min; running, 16.8/18.9 min. U23's cut-off values were (men/women): swim, 18.0/19.4 min, cycling: 63.4/70.1 min; run, 33.9/38.7 min. Conclusion Cycling was the discipline with the greatest influence on overall performance for both men and women in Junior and U23 categories. Moreover, swimming and cycling performances increased over the years for both sexes

Associação entre força, sarcopenia e obesidade sarcopénica com o desempenho funcional de idosas

Sarcopenia e obesidade sarcopénica (OS) são condições geriátricas que apresentam consequências negativas em idosos, entretanto, a associação com a capacidade funcional precisa ser mais investigada. O objetivo do estudo foi verificar a associação entre força muscular, sarcopenia e OS com o desempenho funcional de idosas. Participaram 137 voluntárias (67.76±5.67 anos; 64.63±10.79 kg; 154.13±0.06 cm), submetidas à análise da composição corporal através de DXA. O desempenho funcional foi avaliado por meio dos testes de levantar e sentar, <em>Timed Up &amp; Go</em>, flexão de cotovelo e caminhada de 6 minutos. A força muscular foi avaliada por meio da dinamometria isocinética e pela preensão manual (FPM). A prevalência de sarcopenia e de OS foi de 13.9% e 23.4%, respetivamente. Nenhuma das variáveis funcionais diferiu significativamente entre as mulheres sarcopénicas e não sarcopénicas. As voluntárias classificadas com OS apresentaram maior percentual de gordura e menor massa livre de gordura, porém, não houve diferença para as variáveis funcionais. Em contrapartida, a força muscular (i.e., pico de torque e FPM) apresentou associação com os testes funcionais. Os resultados indicam que não há associação entre as classificações estudadas de sarcopenia e OS com os testes funcionais. Porém, a força muscular apresenta relação positiva com o desempenho funcional de idosas

Comparisons between body adiposity indexes and cutoff values in the prediction of functional disability in older women

The aim of this study was to compare body adiposity indexes and to identify cutoff values in the prediction of disability in older women. Eighty-seven voluntees (67.27±6.45 years) underwent body composition assessment using dual-energy X-ray absorptiometry (DXA) and had five anthropometric indexes measured (Waist Circumference, WC; Waist-to-Height Ratio, WHtR; Body Mass Index, BMI; Body Adiposity Index, BAI; and conicity index). Functionality was assessed from three Senior Fitness Test Battery protocols: 30-second chair stand, 8-foot up-and-go, and 6-minute walk. Pearson’s correlation was conducted to identify the relationship between body adiposity indexes and functionality results. Cutoff values to predict disability were obtained from ROC curves and odds ratio were calculated for the same outcome. Disability prevalence was 36.8%. Scores in the 30-second chair stand, 8-foot up-and-go, and 6-minute walk tests showed stronger associations with WC (r=-0.345; p<0.01), WHtR (r=-0.417; p<0.01) and BAI (r=0.296; p<0.01), respectively. The cutoff values identified were 89.5cm, 39.2%, 26.93kg/m2, 34.6%, 0.51cm and 1.23 for WC, DXA-derived body fat percentage, BMI, BAI, WHtR and conicity index, respectively. WC showed greater odds ratio for disability outcome (odds ratio: 3.16; CI: 1.3–7.8). WC showed strong relationship with functional tests and its cutoff values exhibited predicting skill for disability in older women

Cut-Off Values in the Prediction of Success in Olympic Distance Triathlon

Cut-off points and performance-related tools are needed for the development of the Olympic distance triathlon. The purposes of the present study were (i) to determine cut-off values to reach the top three positions in an Olympic distance triathlon; (ii) to identify which discipline present the highest influence on overall race performance and if it has changed over the decades. Data from 1989 to 2019 (n = 52,027) from all who have competed in an official Olympic distance triathlon events (World Triathlon Series and Olympics) were included. The cut-off value to achieve a top three position was calculated. Linear regressions were applied for performance trends overall and for the top three positions of each race. Men had cut-off values of: swimming = 19.5 min; cycling = 60.7 min; running = 34.1 min. Women’s cut-off values were: swimming = 20.7 min; cycling = 71.6 min; running = 38.1 min. The running split seemed to be the most influential in overall race time regardless of rank position or sex. In conclusion, cut-offs were established, which can increase the chances of achieving a successful rank position in an Olympic triathlon. Cycling is the discipline with the least influence on overall performance for both men and women in the Olympic distance triathlon. This influence pattern has not changed in the last three decades

Association between obesity, risk of falls and fear of falling in older women

<div><p>Abstract The aim of this cross-sectional study was to investigate the association between obesity, risk of falls and fear of falling in older women. Two hundred and twenty-six volunteers (68.05 ± 6.22 years, 68.06 ± 11.79 kg, 1.56 ± 0.06 m) were classified as normal weight, overweight or obese, according to the body mass index. Risk of falls and fear of falling were evaluated using QuickScreen Clinical Falls Risk Assessment and Falls Efficiency Scale – International (FES-I), respectively. Comparisons between groups were conducted using Chi-square and ANOVA One-way tests. The significance level was set at p< 0.05. Obesity was associated with greater probability of falls (p< 0.001), which may be partly explained by decreased muscle strength (p< 0.001) and reaction time (p< 0.001). In addition, significant differences between groups was observed in FES-I score (p< 0.01), with obese women showing more pronounced fear of falling (30.10 ± 8.4) than normal weigh (25. 33 ± 7.11, p< 0.01) and overweight subjects (26.97 ± 7.05, p< 0.05). These findings corroborate previous evidence pointing obesity as a major risk factor for falls. Therefore, health professionals dealing with fall prevention should consider the effects of overweight.</p></div

Frailty syndrome in older adults from the community and long-term care institutions: an exploratory analysis

OBJECTIVES: To investigate the association between Frailty syndrome, lipid profile, anthropometric variables, and the functional capacity of older adults; and to analyze an explanatory model of variables with higher predictive capacity for Frailty syndrome. METHODS: This cross-sectional study included 36 and 86 older adults residing in long-term care facilities and in their households, respectively. Anamnesis was followed by evaluation of anthropometric data, risk of falls, functional tests, and biochemical tests. Frailty syndrome was determined according to the criteria suggested by Fried et al. RESULTS: Geriatric patients classified as frail "were older; had higher medication consumption; and presented lower performance in handgrip strength, sit-to-stand, and gait J2 speed tests as compared to pre- and non-frail older adults. CONCLUSION: Gait speed and sit-to-stand tests were significant predictors of Frailty syndrome. Specifically, a good performance in these tests represents a protection factor against Frailty syndrome. Furthermore, gait speed performance was explained by age, handgrip strength performance, and frailty status, while sit-to-stand performance was explained by risk of falls and muscular strength.</p