Maximal step-up height as a novel assessment of leg muscle strength and function : methodological and clinical studies

Physical performance is a strong predictor for morbidity and premature death and there is an increasing interest in the role of sarcopenia in many chronic diseases. There is a need for simple, robust and valid tests for assessing muscle strength and function in clinical practice. A novel maximal step-up test (MST) was developed and standardised to fulfil this need. The aims of this thesis were to study the repeatability and validity of MST (Study I) and to study the associations to age, anthropometric variables, maximal oxygen uptake (VO2 max) and self-reported physical function before and after a 3-month group training intervention programme (Study II). Furthermore, the aim was to study the long-term effects of the intervention programme on maximal step-up height (MSH) after an average of 22 months (Study III). In Study I, MSH was tested with MST on middle-aged women and men (30/30) with capacity to work. 178 female patients were recruited from primary health care for Study II, all of whom had joint and muscular problems and most of whom also had reduced capacity to work, metabolic risk factors and other chronic diseases. For Study III, 101 out of these female patients were recruited. They participated in a 3-month group training intervention programme, which included three sessions per week of mixed aerobic fitness and strength training. The repeatability of MSH between test occasions and between testers was 6 cm in Study I and 4 cm between testers at 22-month follow-up in Study III. In Study I, MSH was significantly correlated to isokinetic knee extension peak torque (r=0.68, p<0.001), self-reported physical function (r=0.29, p=0.03) as well as sex, age, weight and body mass index (BMI). MSH above 32 cm discriminated subjects with no limitation in self-reported physical function. In Study II, at baseline and after the 3-month intervention MSH was negatively correlated to age, body weight and waist circumference and positively correlated to self-reported physical function, VO2 max and height. MSH correlated to training intensity at follow-up. Changes in MSH were significantly correlated to changes in waist circumference and physical function regardless of age and changes in VO2 max. MSH below 24 cm discriminated female patients with self-reported severe limitation in physical function. The long-term investigation in Study III showed that MSH increased significantly from 27.2 (5.7) cm at baseline to 29.0 (5.5) cm after three months and thereafter decreased to 25.2 (5.5) cm at the long-term follow-up. Time to follow-up (B=-0.42, p<0.001) and change in BMI (B=-0.29, p=0.012) correlated significantly to changes in MSH. Waist circumference, VO2 max, physical function and exercise/physical activity levels were significantly improved at long-term follow-up, while BMI did not change. In a univariate logistic regression model, maintenance of MSH correlated to the extent of mixed training (OR 3.33, 95% CI 1.25-8.89). In a multivariate logistic regression model adjusted for important factors, the correlation was not significant. However, MSH was significantly higher in individuals participating in 2-3 sessions of exercise per week compared to one session. In conclusion, the novel maximal step-up test assessing maximal step-up height is considered to be a useful and reliable test for leg function in clinical practice. It may also function as an indicator of metabolic health. The results of a 3-month group training intervention programme with 2-3 sessions per week of mixed aerobic fitness and strength training demonstrated increasing maximal step-up height, improved fitness and decreased risk in female patients with elevated cardio-metabolic risk. After an average of 22 months without regular group training, maximal step-up height was reduced again, while positive effects remained for waist circumference, VO2 max, physical function and physical activity. However, regular group exercise 2-3 times per week with mixed aerobic fitness and strength training was associated with maintenance of maximal step-up height in a subgroup of women. Brisk walking for at least 150 minutes per week was not sufficient to maintain maximal step-up height in a subgroup of women

Fall and Injury Prevention in Residential Care—Effects in Residents with Higher and Lower Levels of Cognition

Artikkelen omhandler en studie hvor hensikten var å evaluere effekten av et program for forebygging av fall og fallskade hos eldre med ulikt kognitivt funksjonsnivå.To evaluate the effectiveness of a multifactorial fall and injury prevention program in older people with higher and lower levels of cognition. A preplanned subgroup comparison of the effectiveness of a cluster‐randomized, nonblinded, usual‐care, controlled trial. Nine residential facilities in Umeå, Sweden. All consenting residents living in the facilities, aged 65 and older, who could be assessed using the Mini‐Mental State Examination (MMSE; n = 378). An MMSE score of 19 was used to divide the sample into one group with lower and one with higher level of cognition. The lower MMSE group was older (mean ± standard deviation = 83.9 ± 5.8 vs 82.2 ± 7.5) and more functionally impaired (Barthel Index, median (interquartile range) 11 (6–15) vs 17 (13–18)) and had a higher risk of falling (64% vs 36%) than the higher MMSE group. A multifactorial fall prevention program comprising staff education, environmental adjustment, exercise, drug review, aids, hip protectors, and postfall problem‐solving conferences. The number of falls, time to first fall, and number of injuries were evaluated and compared by study group (intervention vs control) and by MMSE group. A significant intervention effect on falls appeared in the higher MMSE group but not in the lower MMSE group (adjusted incidence rates ratio of falls = .016 and = .121 and adjusted hazard ratio < .001 and = .420, respectively). In the lower MMSE group, 10 femoral fractures were found, all of which occurred in the control group ( = .006). The higher MMSE group experienced fewer falls after this multifactorial intervention program, whereas the lower MMSE group did not respond as well to the intervention, but femoral fractures were reduced in the lower MMSE group

Repeatability and validity of a standardised maximal step-up test for leg function-a diagnostic accuracy study

<p>Abstract</p> <p>Background</p> <p>Objectively assessed physical performance is a strong predictor for morbidity and premature death and there is an increasing interest in the role of sarcopenia in many chronic diseases. There is a need for robust and valid functional tests in clinical practice. Therefore, the repeatability and validity of a newly developed maximal step up test (MST) was assessed.</p> <p>Methods</p> <p>The MST, assessing maximal step-up height (MSH) in 3-cm increments, was evaluated in 60 healthy middle-aged subjects, 30 women and 30 men. The repeatability of MSH and the correlation between MSH and isokinetic knee extension peak torque (IKEPT), self-reported physical function (SF-36, PF), patient demographics and self-reported physical activity were investigated.</p> <p>Results</p> <p>The repeatability between occasions and between testers was 6 cm. MSH (range 12-45 cm) was significantly correlated to IKEPT, (<it>r </it>= 0.68, <it>P </it>< 0.001), SF-36 PF score, (<it>r </it>= 0.29, <it>P </it>= 0.03), sex, age, weight and BMI. The results also show that MSH above 32 cm discriminates subjects in our study with no limitation in self-reported physical function.</p> <p>Conclusions</p> <p>The standardised MST is considered a reliable leg function test for clinical practice. The MSH was related to knee extension strength and self-reported physical function. The precision of the MST for identification of limitations in physical function needs further investigation.</p

Negative associations between step-up height and waist circumference in 8-year-old children and their parents.

AIM: To study cross-sectional relationships between step-up height and waist circumference (WC), a potential proxy for sarcopenic obesity, in Swedish children and parents. METHODS: Participants were recruited from Swedish schools in disadvantaged areas in 2017. Height, body weight, WC and maximal step-up height were measured in 67 eight-year-old children and parents: 58 mothers, with a mean age of 38.5 and 32 fathers, with a mean age of 41.3. Sedentary time and physical activity were registered by an accelerometer. Associations between maximal step-up height and WC were analysed using Pearson's correlation and adjusted linear regression. RESULTS: Abdominal obesity, WC ≥ 66 centimetres (cm) in children, ≥88 cm in women and ≥102 cm in men, was observed in 13% and 35% of girls and boys, and in 53% and 34% among mothers and fathers, respectively. Negative associations between maximal step-up height and WC were found for children (r = -0.37, p = 0.002) and adults (mothers r = -0.58, p &lt; 0.001, fathers r = -0.48, p = 0.006). The associations remained after adjustments for height, body mass index (BMI) and physical activity in adults. Reduced muscle strength clustered within families (r = 0.54, p &lt; 0.001). CONCLUSION: Associations between reduced muscle strength and abdominal obesity were observed in children and parents. Sarcopenic obesity may need more attention in children. Our findings support family interventions

Predicting falls in residential care by a risk assessment tool, staff judgement, and history of falls

BACKGROUND AND AIMS: It is of great importance to consider whether a tool's predictive value is generalizable to similar samples in other locations. Numerous fall prediction systems have been developed, but very few are evaluated over a different time period in a different location. The purpose of this study was to validate the predictive accuracy of the Mobility Interaction Fall (MIF) chart, and to compare it to staff judgement of fall risk and history of falls. METHODS: The MIF chart, staff judgement, and fall history were used to classify the risk of falling in 208 residents (mean age 83.2 +/- 6.8 years) living in four residential care facilities in northern Sweden. The MIF chart includes an observation of the ability to walk and simultaneously interact with a person or an object, a vision test, and a concentration rating. Staff rated each resident's risk as high or low and reported the resident's history of falls during the past 6 months. Falls were followed up for 6 months. RESULTS: During the follow-up period, 104 residents (50%) fell at least once indoors. Many of the factors commonly associated with falls did not differ significantly between residents who fell at least once and residents who did not fall. In this validating sample the predictive accuracy of the MIF chart was notably lower than in the developmental sample. A combination of any two of the MIF chart, staff judgement, and history of falls was more accurate than any approach alone; more than half of the residents classified as 'high risk' by two approaches sustained a fall within 3 months. CONCLUSIONS: Residents classified as 'high risk' by any two of the MIF chart, staff judgement, and history of falls should be regarded as particularly prone to falling and in urgent need of preventive measures.Upprättat; 2003; 20070222 (andbra)</p

Metaller och organiska miljögifter i marinbiota, trend- och områdesövervakning

This report gives a summary of the monitoring activities within the national Swedishcontaminant programme in marine biota. It is the result from the joint efforts of: theInstitute of Applied Environmental Research at Stockholm University (analyses oforganochlorines), the Centre for Environmental Monitoring at the University of Agriculture(analyses of heavy metals) and the Contaminant Research Group at the Swedish Museumof Natural History (co-ordination, sample collection administration, sample preparation,recording of biological variables, minor additional analyses of organochlorines, storage offrozen biological tissues in the Environmental Specimen Bank for retrospective studies,data preparation and statistical evaluation). The monitoring programme is financiated by theEnvironmental Protection Agency (EPA) in Sweden.The data of concern in this report represent the bioavailable part of the investigatedcontaminants i.e. the part that has virtually passed through the biological membranes andmay cause biological effects. The objectives of the monitoring program in marine biotacould be summarised as follows:• to estimate the levels and the normal variation of various contaminants in marine biotafrom several representative sites, uninfluenced by local sources, along the Swedish coasts.The goal is to describe the general contaminant status and to supply reference values forregional and local monitoring programmes• to monitor long term time trends and to estimate the rate of found changes.quantified objective: to detect an annual change of 10% within a time period of 10 years with a power of 80%at a significance level of 5%.• to estimate the response in marine biota of measures taken to reduce the discharges ofvarious contaminantsquantified objective: to detect a 50% decrease within a time period of 10 years with a power of 80% at asignificance level of 5%.• to detect incidents of regional influence or widespread incidents of ‘Chernobyl’-character and to act as watchdog monitoring to detect renewed usage of bannedcontaminants.quantified objective: to detect an increase of 200% a single year with a power of 80% at a significance level of5%.• to indicate large scale spatial differencesquantified objective: to detect differences of a factor 2 between sites with a power of 80% at a significancelevel of 5%.• to explore the development and regional differences of the composition and pattern ofe.g. PCB’s, HCH’s and DDT’s as well as the ratios between various contaminants.• the time series are also relevant for human consumption since important commercial fishspecies like herring and cod are sampled. A co-operation with the Swedish FoodAdministration is established. Sampling is also co-ordinated with SSI (Swedish RadiationProtection Authority) for analysing radionuclides in fish and blue mussels (HELCOM,1992).• all analysed, and a large number of additional specimens, of the annually systematicallycollected material are stored frozen in the Environmental Specimen Bank.. This invaluable5material enables future retrospective studies of contaminants impossible to analyse today aswell as control analyses of suspected analytical errors.• although the programme is focused on contaminant concentration in biota, also thedevelopment of biological variables like e.g. condition factor (CF), liver somatic index(LSI) and fat content are monitored at all sites. At a few sites, integrated monitoring withfish physiology and population are running in co-operation with the University ofGothenburg and the Swedish Fishery Board.• experiences from the national program with several time series of over 25 years can beused in the design of regional and local monitoring programmes.• the perfectly unique material of high qualityand long time series is further used to explorerelationships among biological variables and contaminants concentrations in varioustissues; the effects of changes in sampling strategy, the estimates of variance componentsand the influence on the concept of power etc.• the accessibility of high quality data collected and analysed in a consistent manner is anindispensable prerequisite to evaluate the validity of hypothesis and models concerning thefate and distribution of various contaminants. It could furthermore be used as input of ‘real’data in the ongoing model building activities concerning marine ecosystems in general andin the Baltic and North Sea environment in particular.• the contaminant programme in marine biota constitute an integrated part of the nationalmonitoring activities in the marine environment as well as of the international programmeswithin ICES, OSPARCOM and HELCOM.The present report displays the timeseries of analysed contaminants in biota andsummarises the results from the statistical treatment. It does not in general give thebackground or explanations to significant changes found in the timeseries. Increasingconcentrations thus, urge for intensified studies.Short comments are given for temporal trends as well as for spatial variation and, for somecontaminants, differences in geometric mean concentration between various species caughtat the same site. Sometimes notes of seasonal variation and differences in concentrationbetween tissues in the same species are given. This information could say something aboutthe relative appropriateness of the sampled matrix and be of help in designing monitoringprogrammes. In the temporal trend part, an extract of the relevant findings is summarised inthe 'conclusion'-paragraph. It should be stressed though, that geographical differences maynot reflect antropogenic influence but may be due to factors like productivity, temperature,salinity etc.The report is continuously updated. The date of the latest update is reported at the beginningof each chapter. The creation date of each figure is written in the lower left corner

A randomized controlled trial of fall prevention by a high-intensity functional exercise program for older people living in residential care facilities

BACKGROUND AND AIMS: Falls are particularly common among older people living in residential care facilities. The aim of this randomized controlled trial was to evaluate the effectiveness of a high-intensity functional exercise program in reducing falls in residential care facilities. METHODS: Participants comprised 191 older people, 139 women and 52 men, who were dependent in activities of daily living. Their mean±SD score on the Mini-Mental State Examination was 17.8±5.1 (range 10-30). Participants were randomized to a high-intensity functional exercise program or a control activity, consisting of 29 sessions over 3 months. The fall rate and proportion of participants sustaining a fall were the outcome measures, subsequently analysed using negative binominal analysis and logistic regression analysis, respectively. RESULTS: During the 6- month follow-up period, when all participants were compared, no statistically significant differences between groups were found for fall rate (exercise group 3.6 falls per person years [PY], control group 4.6 falls per PY), incidence rate ratio (95% CI) 0.82 (0.49-1.39), p=0.46, or the proportion of participants sustaining a fall (exercise 53%, control 51%), odds ratio (95% CI) 0.95 (0.52-1.74), p=0.86. A subgroup interaction analysis revealed that, among participants who improved their balance during the intervention period, the exercise group had a lower fall rate than the control group (exercise 2.7 falls per PY, control 5.9 falls per PY), incidence rate ratio (95% CI) 0.44 (0.21-0.91), p=0.03. CONCLUSIONS: In older people living in residential care facilities, a high-intensity functional exercise program may prevent falls among those who improve their balance.Validerad; 2008; 20080626 (eriros)</p

I exercise to postpone death - Interviews with persons with hip and/or knee osteoarthritis who are attending an osteoarthritis school

Background: Physical activity (PA) and exercise constitute the first line of treatment for osteoarthritis (OA) of the hip and/or knee. Even though the symptoms may vary, OA should be considered a chronic disease and therefore PA and exercise should be performed lifelong. That needs knowledge and motivation. Purpose: The purpose of this study was to explore and create a deeper understanding of the motivational processes for PA and exercise for persons with hip and/or knee OA who have participated in a self-management program OA school that included long-term exercise supervised by physical therapists. Methods: Twenty-two in-depth interviews were conducted with 18 participants recruited from the OA school at a Physical Therapy Rehabilitation Clinic in Sweden. The interviews were analyzed with qualitative content analysis. Results: The analysis resulted in one main theme, Developing health literacy to encourage motivational processes for PA and exercise in OA and four themes: 1) meeting an established self-management program; 2) carrying my life history; 3) understanding the intelligence of the body; and 4) growing in existential motivation Conclusion: Motivation for being physically active and to exercise, the life history in relation to PA and what creates existential motivation are important areas to ask questions about when people come to OA schools. Knowledge about the signals of the body connected to OA should be implemented in OA schools in order to motivate people to live an active life despite OA. Health literacy and the awareness of how PA can postpone death are likely to be important for existential motivation

I exercise to postpone death - Interviews with persons with hip and/or knee osteoarthritis who are attending an osteoarthritis school

Background: Physical activity (PA) and exercise constitute the first line of treatment for osteoarthritis (OA) of the hip and/or knee. Even though the symptoms may vary, OA should be considered a chronic disease and therefore PA and exercise should be performed lifelong. That needs knowledge and motivation. Purpose: The purpose of this study was to explore and create a deeper understanding of the motivational processes for PA and exercise for persons with hip and/or knee OA who have participated in a self-management program OA school that included long-term exercise supervised by physical therapists. Methods: Twenty-two in-depth interviews were conducted with 18 participants recruited from the OA school at a Physical Therapy Rehabilitation Clinic in Sweden. The interviews were analyzed with qualitative content analysis. Results: The analysis resulted in one main theme, Developing health literacy to encourage motivational processes for PA and exercise in OA and four themes: 1) meeting an established self-management program; 2) carrying my life history; 3) understanding the intelligence of the body; and 4) growing in existential motivation Conclusion: Motivation for being physically active and to exercise, the life history in relation to PA and what creates existential motivation are important areas to ask questions about when people come to OA schools. Knowledge about the signals of the body connected to OA should be implemented in OA schools in order to motivate people to live an active life despite OA. Health literacy and the awareness of how PA can postpone death are likely to be important for existential motivation