The effects of a muscle resistance program on the functional capacity, knee extensor muscle strength and plasma levels of IL-6 and TNF-α in pre-frail elderly women: a randomized crossover clinical trial - a study protocol

<p>Abstract</p> <p>Background</p> <p>With the increase in the elderly population, a growing number of chronic degenerative diseases and a greater dependency on caregivers have been observed. Elderly persons in states of frailty remain more susceptible to significant health complications. There is evidence of an inverse relationship between plasma levels of inflammatory mediators and levels of functionality and muscle strength, suggesting that muscle-strengthening measures can aid in inflammatory conditions. The purpose of this study will be verified the effect of a muscle-strengthening program with load during a ten-week period in pre-frail elderly women with attention to the following outcomes: (1) plasma levels of interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α), (2) functional capacity and (3) knee extensor muscle strength.</p> <p>Methods/Design</p> <p>The study design is a randomized crossover clinical trial evaluating 26 elderly women (regardless of their race and/or social condition) who are community residents, older than 65, and classified as pre-frail according to the criteria previously described by Fried et al. (2004). All subjects will be assessed using the Timed up and go and 10-Meter Walk Test functional tests. The plasma levels of IL-6 and TNF-α will be assessed by ELISA (<it>enzyme-linked immunosorbent assay</it>) with high sensitivity kits (Quantikine^®HS, R&D Systems Minneapolis, MN, U.S.). Knee extensor muscle strength will be assessed using the <it>Byodex System 3 Pro</it>^{<it>® </it>}isokinetic dynamometer at angular speeds of 60 and 180°/s. The intervention will consist of strengthening exercises of the lower extremities at 50 to 70% of 1RM (maximal resistance) three times per week for ten weeks. The volunteers will be randomized into two groups: group E, the intervention group, and group C, the control group that did not initiate any new activities during the initial study period (ten weeks). After the initial period, group C will begin the intervention and group E will maintain everyday activities without exercising. At the end of the total study period, all volunteers will be reassessed.</p> <p>Discussion</p> <p>To demonstrate and discuss possible influences of load-bearing exercises on the modification of plasma levels of IL-6 and TNF-α and in the functional performance of pre-frail elderly women.</p> <p>Trial Registration</p> <p>ISRCTN62824599</p

Efeito de um programa de resistência muscular na capacidade funcional e na força muscular dos extensores do joelho em idosas pré-frágeis da comunidade: ensaio clínico aleatorizado do tipo crossover Impact of resistance exercise program on functional capacity and muscular strength of knee extensor in pre-frail community-dwelling older women: a randomized crossover trial

CONTEXTUALIZAÇÃO: Na síndrome de fragilidade em idosos, há diminuição das reservas de energia e resistência aos estressores, com aumento da vulnerabilidade. OBJETIVO: Verificar o efeito do treinamento de força muscular com carga na capacidade funcional e força muscular dos extensores do joelho e sua associação, após treinamento, em idosas pré-frágeis da comunidade. MÉTODOS:Participaram 32 idosas, pré-frágeis, da comunidade. Excluíram-se aquelas com Miniexame do Estado Mental (MEEM) incompatível; cirurgias ortopédicas dos membros inferiores; fraturas; doenças neurológicas; doenças inflamatórias agudas; neoplasias; atividade física regular; uso de medicamento com ação no sistema imunológico e sem marcha independente. Avaliou-se a capacidade funcional (Timed Up and Go - TUG e velocidade de marcha - TC10) e a força muscular dos extensores do joelho (Byodex System 3 Pro®) nas velocidades angulares de 60 e 180(0)/s. Para o fortalecimento muscular, utilizou-se carga de 75% de resistência máxima (1RM), durante dez semanas, três vezes/semana. A análise estatística foi feita pela ANOVA e Spearman (&#945;=5%). RESULTADOS: Após o treinamento, houve melhora estatística do trabalho normalizado em 180(0)/s (F=12,71, p=0,02), na potência, em 180(0)/s (F=15,40, p=0,02) e na capacidade funcional (TUG, F=9,54, p=0,01; TC10, F=3,80, p=0,01). Houve boa correlação negativa significativa do TUG com as medidas de trabalho normalizado em 60 e 180(0)/s (r=-0,65, p=0,01; r=-0,72, p=0,01). CONCLUSÃO: O treinamento produziu melhora da potência muscular e capacidade funcional. A melhora da potência associou-se à melhora funcional, importante variável para a qualidade de vida de idosas pré-frágeis. Artigo registrado no ISRCT register sob o número ISRCTN62824599.<br>BACKGROUND: Frailty syndrome in elderly people is characterized by a reduction of energy reserves and also by a decreased of resistance to stressors, resulting in an increase of vulnerability. OBJECTIVE: The aim of this study was to verify the effect of a muscle-strengthening program with load in pre-frail elder women with regards to the functional capacity, knee extensor muscle strength and their correlation. METHODS: Thrity-two pre-frail community-dwelling women participated in this study. Potential participants with cognitive impairment (MEEM), lower extremities orthopedic surgery, fractures, inability to walk unaided, neurological diseases, acute inflammatory disease, tumor growth, regular physical activity and current use of immunomodulators were excluded. All partcipants were evaluated by a blinded assessor using: Timed up and go (TUG), 10-Meter Walk Test (10MWT) and knee extensor muscle strength (Byodex System 3 Pro® isokinetic dynamometer at angular speeds of 60 and 180(0)/s). The intervention consisted of strengthening exercises of the lower extremities at 70% of 1RM, three times/ week for ten weeks. The statistical analysis was performed using the ANOVA and Spearman tests RESULTS: After the intervention, it was observed statistical significance on the work at 180(0)/s (F=12.71, p=0.02), on the power at 180(0)/s (F=15.40, p=0.02) and on the functional capacity (TUG, F=9.54, p=0.01; TC10, F=3.80, p=0.01). There was a good negative and statistically significant correlation between the TUG and work at 60(0)/s, such as the TUG and work at 180(0)/s (r=-0.65, p=0.01; r=-0.72, p=0.01). CONCLUSION: The intervention improved the muscular power and the functional capacity. The increase of the power correlated with function, which is an important variable of the quality of life in the pre-frail elders. Article registered in the ISRCT register under number ISRCTN62824599

Impacto do alongamento estático no ganho de força muscular dos extensores de joelho em idosas da comunidade após um programa de treinamento Impact of static stretching on the gain in knee-extensor strength of community-dwelling older women after a training program

CONTEXTUALIZAÇÃO: A diminuição da força muscular em idosos tem impacto na funcionalidade. Programas de reforço muscular são propostos, porém existem controvérsias quanto ao efeito de alongamentos prévios no ganho de força muscular. OBJETIVO: Verificar o impacto do alongamento estático no ganho de força dos músculos extensores de joelho em idosas da comunidade após programa de treinamento. MÉTODOS:Trata-se de um estudo quase-experimental, em que se realizou um programa de exercícios de fortalecimento muscular dos extensores de joelho durante 10 semanas, com avaliação final de 12 idosas da comunidade divididas em dois grupos: AE - exercícios com carga e alongamentos prévios em todas as sessões, média de idade de 73,8 (±5,36) anos e E - mesmos exercícios com carga do grupo acima, sem a realização de alongamentos prévios, média de idade de 72,14 (±5,43) anos. Para avaliar o ganho de força muscular dos extensores de joelho, utilizou-se o dinamômetro isocinético Biodex System 3 Pro, no modo concêntrico, na velocidade de movimento angular de 60 e 180º/segundos (s) e, para a análise, a diferença das médias da pré e da pós-intervenção da variável trabalho, normalizada pelo peso corporal. RESULTADOS: Os dados apresentaram-se normais pelo teste de Shapiro-Wilk (p>0,266). Quando comparadas as médias da diferença da pré e da pós-intervenção pelo teste t para amostras independentes, não houve diferença significativa em nenhum dos membros e nas velocidades avaliadas (p>0,383). CONCLUSÃO: O alongamento estático prévio não interferiu no ganho de força muscular após um programa de fortalecimento de 10 semanas na população estudada. Artigo registrado no ISRCTN register sob o número ISRCTN62824599.<br>BACKGROUND: The decrease in muscle strength in older adults has an impact on functionality. Muscle strengthening programs have been proposed, however there is some controversy surrounding the effects of stretching prior to strengthening exercises on muscle strength gain. OBJECTIVE: To verify the impact of static stretching on the gain in knee-extensor strength of community-dwelling elderly women after a training program. METHODS: This was a quasi-experimental study that included a ten-week knee-extensor strengthening program and a final assessment of 12 community-dwelling elderly women divided into two groups: group SE - strengthening exercises with prior static stretching in all sessions, mean age 73.8 (±5.36) years; and group E - same strengthening exercises as SE without prior stretching, mean age 72.14 (±5.43) years. To measure knee-extensor strength gains, we used the isokinetic dynamometer Biodex System 3 Pro, in concentric mode at angular velocities of 60º and 180º/s, and for statistical analysis we used the difference between pre- and post-intervention means of work adjusted by body weight. RESULTS: The data showed normality in the Shapiro-Wilk test (p>0.266). When comparing the differences between the pre- and post-intervention means using the t test for independent samples, there was no significant difference in any of the limbs at the velocities evaluated (p>0.383). CONCLUSION: Previous static stretching did not interfere in muscle strength gain following a ten-week muscle strengthening program in the population studied. Article registered in the ISRCTN register under number ISRCTN62824599

Total hip arthroplasty in the elderly: impact on functional performance Artroplastia total de quadril em idosos: impacto na funcionalidade

OBJECTIVES: To compare gait and functional performance parameters in elderly subjects who had or had not total hip arthroplasty (THA). METHODS: Our sample comprised 23 elderly subjects (72±6.5 years of age) with a mean of 2.6±1.3 years following THA, named the arthroplasty group (AG) and 23 asymptomatic elderly subjects (70.1±5.9 years of age), named the control group (CG). Case and control subjects were paired by gender, age, body mass index and level of physical activity. The GAITRite® system was used to analyze various gait parameters in four situations: usual speed (US), fast speed (FS), slow speed (SS) and dual task (DT); the Dynamic Gait Index (DGI) and Timed Up and Go test (TUG) methods were used to evaluate functional capacity. The statistical analyses were carried out using the Shapiro-Wilk test, Student's-t-tests for independent samples, chi-square tests, ANOVA for repeated measurements and paired Student's-t-tests. RESULTS: The AG had the worst results for gait speed (AG=1.18±0.13 and CG=1.39±0.09; p=0.012), symmetry index (SI) of step length (AG=3.60±1.01 and CG=1.12±0.59; p=0.000), SI of step time (AG=-2.65±0.92 and CG=0.99±0.74; p=0.000), SI of stance phase (AG=-2.55 and CG=-1.04±0.50; p=0.005), SI of single support phase (AG=-2.17±0.78 and CG=1.21±0.51; p=0.003), DGI (AG=20.04±1.91 and CG=21.69±1.45; p=0.001) and TUG (AG=14.67±1.94 and CG=10.08±1.49; p=0.001). CONCLUSION: Elderly subjects with a history of THA had changes in gait parameters and lower performance in TUG test even 2.6±1,3 years after surgery, which suggests functional impairment.<br>OBJETIVOS: Comparar os parâmetros da marcha e o desempenho funcional de idosos com e sem artroplastia total de quadril (ATQ). MÉTODOS: Foram selecionados 23 idosos (72±6,5 anos) após média de 2,6±1,3 anos de ATQ e 23 idosos assintomáticos (70,1±5,9 anos), pareados por gênero, idade, índice de massa corpórea (IMC) e nível de atividade física. Utilizou-se o sistema GAITRite® em quatro situações distintas: velocidades habitual (VH), rápida (VR), lenta (VL) e tarefa dupla (TD). A capacidade funcional foi avaliada pelo Dynamic Gait Index (DGI) e Timed Up and Go (TUG). Na análise estatística, utilizaram-se os testes Shapiro-Wilk, t-Student para amostras independentes, Qui-quadrado, ANOVA com medidas repetidas e t-Student pareado. RESULTADOS: O grupo artroplastia (GA) apresentou piores resultados estatisticamente significantes no que se refere à velocidade de marcha (VM) (GA=1,18±0,13 e GC=1,39±0,09; p=0,012), índice de simetria (IS) do comprimento do passo (GA=3,60±1,01 e GC=1,12±0,59; p=0,000), IS do tempo do passo (GA=-2,65±0,92 e GC=0,99±0,74; p=0,000), IS da duração da fase de apoio (GA=-2,55 e GC=-1,04±0,50; p=0,005), IS da duração da subfase de apoio único (GA=-2,17±0,78 e GC=1,21±0,51; p=0,003), DGI (GA=20,04±1,91 e GC=21,69±1,45; p=0,001) e TUG (GA=14,67±1,94 e GC=10,08±1,49; p=0,001). CONCLUSÃO: Idosos com ATQ apresentaram alterações nos parâmetros da marcha, mesmo após 2,6±1,3 anos de cirurgia, e pior desempenho no teste TUG, indicando comprometimento funcional

Diagnostic accuracy of the short physical performance battery for detecting frailty in older people

The Short Physical Performance Battery (SPPB) is widely used to predict negative health-related outcomes in older adults. However, the cutoff point for the detection of the frailty syndrome is not yet conclusive. The aim of this study was to determine the diagnostic value of the SPPB for detecting frailty in community-dwelling older adults. This was a population-based cross-sectional study focusing on households in urban areas. A total of 744 people who were 65 years old or older participated in this study. Frailty was determined by the presence of 3 or more of the following components: unintentional weight loss, self-reported fatigue, weakness, low level of physical activity, and slowness. Diagnostic accuracy measures of the SPPB cutoff points were calculated for the identification of frailty (individuals who were frail) and the frailty process (individuals who were considered to be prefrail and frail). Receiver operating characteristic curves were constructed. Odds ratios for frailty and the frailty process and respective CIs were calculated on the basis of the best cutoff points. A bootstrap analysis was conducted to confirm the internal validity of the findings. The best cutoff point for the determination of frailty was ≤ 8 points (sensitivity = 79.7%; specificity = 73.8%; Youden J statistic = 0.53; positive likelihood ratio = 3.05; area under the curve = 0.85). The best cutoff point for the determination of the frailty process was ≤ 10 points (sensitivity = 75.5%; specificity = 52.8%; Youden J statistic = 0.28; positive likelihood ratio = 1.59; area under the curve = 0.76). The adjusted odds of being frail and being in the frailty process were 7.44 (95% CI = 3.90-14.19) and 2.33 (95% CI = 1.65-3.30), respectively. External validation using separate data was not performed, and the cross-sectional design does not allow SPPB predictive capacity to be established. The SPPB might be used as a screening tool to detect frailty syndrome in community-dwelling older adults, but the cutoff points should be tested in another sample as a further validation step9098CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQ17/200

Influence of dual task and frailty on gait parameters of older community-dwelling individuals

Background: Gait parameters such as gait speed (GS) are important indicators of functional capacity. Frailty Syndrome is closely related to GS and is also capable of predicting adverse outcomes. The cognitive demand of gait control is usually explored with dual-task (DT) methodology. Objective: To investigate the effect of DT and frailty on the spatio-temporal parameters of gait in older people and identify which variables relate to GS. Method: The presence of frailty was verified by Fried's Frailty Criteria. Cognitive function was evaluated with the Mini-Mental State Exam (MMSE) and gait parameters were analyzed through the GAITRite(r) system in the single-task and DT conditions. The Kolmogorov-Smirnov, ANOVA, and Pearson's Correlation tests were administered. Results: The participants were assigned to the groups frail (FG), pre-frail (PFG), and non-frail (NFG). During the DT, the three groups showed a decrease in GS, cadence, and stride length and an increase in stride time (p<0.001). The reduction in the GS of the FG during the DT showed a positive correlation with the MMSE scores (r=730; p=0.001) and with grip strength (r=681; p=0.001). Conclusions: Gait parameters are more affected by the DT, especially in the frail older subjects. The reduction in GS in the FG is associated with lower grip strength and lower scores in the MMSE. The GS was able to discriminate the older adults in the three levels of frailty, being an important measure of the functional capacity in this population

Functional Capacity and Inflammatory Mediators in Elderly Residents of Counties with Different Human Development Index

A number of studies have indicated that certain factors, including socioeconomic status and education, are associated with the functional health status of the elderly. Another relevant factor in aging is chronic subliminal inflammation, with increased levels of circulating inflammatory cytokines such as interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), and soluble tumor necrosis factor receptor 1 (sTNFR-1), commonly seen in the elderly. High levels of these inflammatory mediators could impair the functional capacity. In this respect, the aim of this cross-sectional study was to compare plasma levels of inflammatory mediators and functional capacity of older women living in three Brazilian counties with different Human Development Index. We evaluated 154 women aged ≥65 years, regardless of race and/or social status. IL-6 and sTNFR-1 plasma levels were measured by ELISA and the functional capacity by the Short Physical Performance Battery (SPPB) test. Comparison among groups was performed using one-way ANOVA with Bonferroni post hoc correction, Kruskal–Wallis, and Mann–Whitney U tests. Women that lived in one of the counties with high HDI had lower functional capacity (p0.05). Besides this, women from the counties with lower HDI had a higher number of self-reported diseases and higher income (p<0.05). Women that lived in the county with the highest HDI had a higher average education level (p<0.05). The results showed differences in functional capacity and plasma levels of sTNFR-1 between the counties. In addition, the level of education, family income, and number of self-reported diseases show regional diversities in the aging process, suggesting these factors having an influence on inflammatory mediators and functional capacity