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1.  Lipopolysaccharide-Binding Protein, a Surrogate Marker of Microbial Translocation, Is Associated With Physical Function in Healthy Older Adults 
Physical function declines, and markers of inflammation increase with advancing age, even in healthy persons. Microbial translocation (MT) is the systemic exposure to mucosal surface microbes/microbial products without overt bacteremia and has been described in a number of pathologic conditions. We hypothesized that markers of MT, soluble CD14 (sCD14) and lipopolysaccharide (LPS) binding protein (LBP), may be a source of chronic inflammation in older persons and be associated with poorer physical function.
We assessed cross-sectional relationships among two plasma biomarkers of MT (sCD14 and LBP), physical function (hand grip strength, short physical performance battery [SPPB], gait speed, walking distance, and disability questionnaire), and biomarkers of inflammation (C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), TNF-α soluble receptor 1 [TNFsR1]) in 59 older (60–89 years), healthy (no evidence of acute or chronic illness) men and women.
LBP was inversely correlated with SPPB score and grip strength (p = .02 and p < .01, respectively) and positively correlated with CRP (p = 0.04) after adjusting for age, gender, and body mass index. sCD14 correlated with IL-6 (p = .01), TNF-α (p = .05), and TNFsR1 (p < .0001). Furthermore, the correlations between LBP and SPPB and grip strength remained significant after adjusting for each inflammatory biomarker.
In healthy older individuals, LBP, a surrogate marker of MT, is associated with worse physical function and inflammation. Additional study is needed to determine whether MT is a marker for or a cause of inflammation and the associated functional impairments.
PMCID: PMC3636679  PMID: 22960476
Microbial translocation; Inflammation; Physical function; Microbiome
2.  Predictive Value of the Short Physical Performance Battery Following Hospitalization in Older Patients 
Hospitalization represents a stressful and potentially hazardous event for older persons. We evaluated the value of the Short Physical Performance Battery (SPPB) in predicting rates of functional decline, rehospitalization, and death in older acutely ill patients in the year after discharge from the hospital.
Prospective cohort study of 87 patients aged 65 years and older who were able to walk and with a Mini-Mental State Examination score ≥18 and admitted to the hospital with a clinical diagnosis of congestive heart failure, pneumonia, chronic obstructive pulmonary disease, or minor stroke. Patients were evaluated with the SPPB at hospital admission, were reevaluated the day of hospital discharge, and 1 month later. Subsequently, they were followed every 3 months by telephone interviews to ascertain functional decline, new hospitalizations, and vital status.
After adjustment for potential confounders, including self-report activity of daily living and comorbidity, the SPPB score at discharge was inversely correlated with the rate of decline in activity of daily living performance over the follow-up (p < .05). In a multivariable discrete-time survival analysis, patients with poor SPPB scores at hospital discharge (0–4) had a greater risk of rehospitalization or death (odds ratio: 5.38, 95% confidence interval: 1.82–15.9) compared with those with better SPPB scores (8–12). Patients with early decline in SPPB score after discharge also had steeper increase in activity of daily living difficulty and higher risk of rehospitalization or death over the next year.
In older acutely ill patients who have been hospitalized, the SPPB provides important prognostic information. Lower extremity performance-based functional assessment might identify older patients at high risk of poor outcomes after hospital discharge.
PMCID: PMC3011958  PMID: 20861145
SPPB; Hospitalization; Disability; Mortality; Prognosis
3.  Use of the Short Physical Performance Battery Score to Predict Loss of Ability to Walk 400 Meters: Analysis From the InCHIANTI Study 
Early detection of mobility limitations remains an important goal for preventing mobility disability. The purpose of this study was to examine the association between the Short Physical Performance Battery (SPPB) and the loss of ability to walk 400 m, an objectively assessed mobility outcome increasingly used in clinical trials.
The study sample consisted of 542 adults from the InCHIANTI study aged 65 and older, who completed the 400 m walk at baseline and had evaluations on the SPPB and 400 m walk at baseline and 3-year follow-up. Multiple logistic regression models were used to determine whether SPPB scores predict the loss of ability to walk 400 m at follow-up among persons able to walk 400 m at baseline.
The 3-year incidence of failing the 400 m walk was 15.5%. After adjusting for age, sex, education, body mass index, Mini-Mental State Examination, number of medical conditions, and 400 m walk gait speed at baseline, SPPB score was significantly associated with loss of ability to walk 400 m after 3 years. Participants with SPPB scores of 10 or lower at baseline had significantly higher odds of mobility disability at follow-up (odds ratio [OR] = 3.38, 95% confidence interval [CI]: 1.32–8.65) compared with those who scored 12, with a graded response across the range of SPPB scores (OR = 26.93, 95% CI: 7.51–96.50; OR = 7.67, 95% CI: 2.26–26.04; OR = 8.28, 95% CI: 3.32–20.67 for SPPB ≤ 7, SPPB 8, and SPPB 9, respectively).
The SPPB strongly predicts loss of ability to walk 400 m. Thus, using the SPPB to identify older persons at high risk of lower body functional limitations seems a valid means of recognizing individuals who would benefit most from preventive interventions.
PMCID: PMC2655026  PMID: 19182232
Mobility; 400 m walk; Incidence of disability; Functional limitation; Aging
4.  Comparing Pain Severity Versus Pain Location in the MOBILIZE Boston Study: Chronic Pain and Lower Extremity Function* 
This study compared measures of chronic pain, for example, number of pain sites and overall pain severity, in relation to lower extremity function in the older population.
Six hundred older adults (mean age 77.9 years, 64% female) were queried about presence of chronic pain. Number of pain sites was categorized as none, single site, multisite, or widespread. Pain severity was measured in quartiles of the Brief Pain Inventory pain severity subscale. Lower extremity function was assessed by the Short Physical Performance Battery (SPPB), a composite measure of gait speed, balance, and chair stands.
Many older persons reported multisite or widespread pain (40%). Increased pain sites and pain severity were associated with poorer SPPB performance after adjusting for age, sex, height, and weight. With further adjustment for education, comorbid conditions, and depressive symptoms, multisite pain (p < .001) and most severe pain (p < .05) were associated with poorer SPPB performance, but assessed together in the same model, only the association with multisite/widespread pain remained significant (p < .01). When specific joint pain sites were evaluated together, only knee pain was associated with lower SPPB score. Pain severity was independently associated with slower gait, pain location was associated with poorer balance, and chair stands performance was associated with both pain measures.
Although multisite pain rather than pain severity was more strongly associated with overall lower extremity function, differences emerged with specific SPPB subtests. Longitudinal studies are needed to understand risk for lower extremity function decline related to chronic pain characteristics in older adults.
PMCID: PMC2691797  PMID: 19228782
Pain; Mobility; Aging; Lower extremity function; Epidemiology
5.  The Lifestyle Interventions and Independence for Elders Pilot (LIFE-P): 2-Year Follow-up 
It is well recognized that physical activity (PA) is important for older adults; yet, clinicians remain pessimistic about the ability of older adults with compromised function to adhere to long-term treatment and to maintain behavior change once treatment has been terminated.
We examined the functional status of older adults at a field center (Wake Forest University) 2 years after completing 12 months of treatment in the Lifestyle Interventions and Independence for Elders Pilot study. At baseline, participants were randomized to either a PA or a successful aging (SA) control group. Outcome measures included an interview assessment of PA, the Short Physical Performance Battery (SPPB), and performance on a 400-m self-paced walking test.
Two years after the formal intervention had ended, participants who were originally in the PA group continued to engage in more minutes of moderate PA and tended to have better SPPB and walking speed than those in the SA group (effect sizes [ES]: SPPB = 0.40, walking speed = 0.37). Seven (12.7%) participants in the PA group failed the 400-m walk at the 36-month follow-up assessment, whereas this number was 11 (21.6%) in the SA group.
Older adults who have compromised physical function are able to sustain some of the benefits derived from participating in structured PA 2 years after supervised treatment has been terminated.
PMCID: PMC2657174  PMID: 19181715
Aging; Disability; Mobility; SPPB; 400-m walk
6.  Relationship Between Renal Function and Physical Performance in Elderly Hospitalized Patients 
Rejuvenation Research  2012;15(6):545-552.
Chronic kidney disease (CKD) is increasingly recognized as a cause of worsening physical functioning in older patients. The Short Physical Performance Battery (SPPB) is highly reliable in older populations, but no data on older hospitalized patients with different degrees of kidney function are available. We aimed at testing the association between estimated glomerular filtration rate (eGFR) and SPPB, either global score (range 0–12) or its individual components (muscle strength, balance, and walking speed, each ranging from 0 to 4), in a sample of older hospitalized patients. Our series consisted of 486 patients aged 65 or more consecutively enrolled in 11 acute care medical wards participating to a multicenter observational study. eGFR was obtained by the Chronic Kidney Disease Epidemiological Collaboration (CKD-EPI) equation. Physical performance was objectively measured by the SPPB. The relationship between eGFR and SPPB was investigated by multiple linear regression analysis. Physically impaired patients (SPPB total score<5) were older, had lower serum albumin and Mini-Mental State Examination (MMSE) scores as well as higher overall co-morbidity, prevalence of stroke, cancer, and anemia compared to those with intermediate (SPPB=5–8) and good physical performance (SPPB=9–12). Fully adjusted multivariate models showed that eGFR (modeled as 10 mL/min per 1.73 m2 intervals) was independently associated with the SPPB total score (B=0.49; 95% confidence interval [CI]=0.18–0.66; p=0.003), balance (B=0.30; 95% CI=0.10–0.49; p=0.005), and muscle strength (B=0.06; 95% CI=0.01–0.10; p=0.043), but not with walking speed (B=−0.04; 95% CI=−0.09–0.11; p=0.107). In conclusion, reduced renal function is associated with poorer physical performance in older hospitalized patients. SPPB is worthy of testing to monitor changes in physical performance in elderly CKD patients.
PMCID: PMC3549205  PMID: 22950422
7.  Relationship Between Physical Functioning and Physical Activity in the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P) 
To determine if participation in usual moderate-intensity or more vigorous physical activity (MVPA) is associated with physical function performance and to identify socio-demographic, psychosocial and disease-related covariates that may also compromise physical function performance.
Cross-sectional analysis of baseline variables of randomized controlled intervention trial.
Four separate academic research centers.
Four hundred twenty-four older adults aged 70–89 years at risk for mobility-disability (scoring <10 on the Short Physical Performance Battery, SPPB) and able to complete the 400 m walk test within 15 minutes.
Minutes of MVPA (dichotomized according to above or below 150 min•wk−1 of MVPA) assessed by the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire, SPPB score, 400 M walk test, gender, body mass index (BMI), depressive symptoms, age and number of medications.
The SPPB summary score was associated with minutes of MVPA (ρ = 0.16, P = 0.001). In multiple regression analyses, age, minutes of MVPA, number of medications and depressive symptoms were associated with performance on the composite SPPB (P < 0.05). There was an association between 400 m walk time and minutes of MVPA (ρ = −0.18; P = 0.0002). In multiple regression analyses, age, gender, minutes of MVPA, BMI and number of medications were associated with performance on the 400 m walk test (P < 0.05).
Minutes of MVPA, gender, BMI, depressive symptoms, age, and number of medications are associated with physical function performance and all should be taken into consideration in the prevention of mobility-disability.
PMCID: PMC2952066  PMID: 20738437
older adults; mobility-disability; physical function performance; older adults; mobility-disability; physical function performance
8.  COPD as a Systemic Disease: Impact on Physical Functional Limitations 
The American journal of medicine  2008;121(9):789-796.
Although chronic obstructive pulmonary disease (COPD) has a major impact on physical health, the specific impact of COPD on physical functional limitations has not been clearly characterized. We aimed to elucidate the physical functional limitations that are directly attributable to COPD compared to a matched referent group without the condition.
We used the FLOW (Function, Living, Outcomes, and Work) cohort study of adults with COPD (n=1,202) and referent subjects matched by age, sex, and race (n=302) to study the impact of COPD on the risk of a broad array of functional limitations using validated measures: lower extremity function (Short Physical Performance Battery, SPPB), submaximal exercise performance (Six Minute Walk Test, SMWT), standing balance (Functional Reach Test), skeletal muscle strength (manual muscle testing with dynamometry), and self-reported functional limitation (standardized item battery). Multivariate analysis was used to control for confounding by age, sex, race, height, educational attainment, and cigarette smoking.
COPD was associated with poorer lower extremity function (mean SPPB score decrement for COPD vs. referent -1.0 points; 95% CI -1.25 to -0.73 pts) and less distance walked during the SMWT (-334 feet; 95% CI -384 to -282 ft). COPD was also associated with weaker muscle strength in every muscle group tested, including both the upper and lower extremities (p<0.0001 in all cases) and with a greater risk of self-reported functional limitation (OR 6.4; 95% CI 3.7 to 10.9).
A broad array of physical functional limitations were specifically attributable to COPD. COPD affects a multitude of body systems remote from the lung.
PMCID: PMC2548403  PMID: 18724969
pulmonary disease, chronic obstructive; disability evaluation; outcomes assessment
Experimental aging research  2013;39(5):481-492.
Physical performance measures have been found to be strong predictors of adverse outcomes in aging populations. Few studies have examined the predictive ability of physical performance measures exclusively within populations of the very old. This study explores the predictive ability of the Short Physical Performance Battery (SPPB) and its three subcomponents - a timed walk, balance test, and timed repeated chair stands - on mortality in a sample of Mexican- Americans aged 75 and older.
Logistic regression analyses were used with data from the Hispanic Established Population for the Epidemiological Study of the Elderly (Hispanic EPESE), to investigate the relationship between timed walk, balance test, repeated timed chair stands, and the SPPB and mortality over a 2 ½ year period.
We find that being unable to complete the timed walk, the balance test, repeated timed chair stands, or unable to complete any of the SPPB was significantly associated with mortality over 2 ½ years.
These findings indicate that physical performance measures may be less predictive of short term mortality in very old Mexican Americans than previously thought. More research is needed to understand this relationship.
PMCID: PMC3889195  PMID: 24151912
(a) To compare exercise performance and leisure-time physical activity (LTPA) between older Caucasians and African-Americans, (b) to assess the relationship between exercise performance and LTPA, and (c) to determine whether group differences in exercise performance persist after adjusting for differences in LTPA.
A total of 207 Caucasians and 160 African-Americans who were 65 years of age and older participated in this study. Subjects were characterized on exercise performance by a 6-minute walk test, and by a short physical performance battery (SPPB) score consisting of a repeated chair rise test, a standing balance test, and a 4-meter walk test. Additionally, LTPA was assessed using the Minnesota LTPA questionnaire.
African-Americans had a 16% lower SPPB value (P < 0.001), a 14% shorter 6-minute walk distance (P < 0.001), and a 34% lower LTPA value (P < 0.011) than the Caucasians. LTPA was significantly related (P < 0.01) to both SPPB and 6-minute walk distance in both groups. Differences in SPPB and 6-minute walk distance between older Caucasians and African-Americans were no longer present (P > 0.05) after controlling for LTPA.
Older African-Americans had impaired exercise performance and lower LTPA compared to older Caucasians. Racial differences in exercise performance were no longer present after adjusting for differences in LTPA.
PMCID: PMC3193346  PMID: 22003300
Clinical medicine. Geriatrics  2008;2008(1):9-15.
(a) To compare exercise performance and leisue-time physical activity (LTPA) between older men and women, (b) to assess the relationship between exercise performance and LTPA, and (c) to determine whether group differences in exercise performance persist after controlling for LTPA.
A total of 105 women and 155 men who were 65 years of age and older participated in this study. Subjects were characterized on exercise performance by a 6-minute walk test, and by a short physical performance battery (SPPB) consisting of a repeated chair rise test, a standing balance test, and a 4-meter walk test. Additionally, LTPA was assessed using the Minnesota LTPA questionnaire.
Women had a 7% lower SPPB value (P < 0.001), a 12% shorter 6-minute walk distance (P < 0.001), and a 28% lower LTPA value (P < 0.011) than the older men. LTPA was significantly related (P < 0.01) to both SPPB and 6-minute walk distance in the older men and women. Group differences in SPPB and 6-minute walk distance between older men and women were no longer present (P > 0.05) after controlling for LTPA.
Older women have impaired exercise performance and lower LTPA compared to older men. Furthermore, sex differences in exercise performance no longer exist after controlling for LTPA.
PMCID: PMC3679925  PMID: 23772175
Age; Exercise; Gender; Physical Function
12.  Physical Performance and a Test of Gaze Stabilization in Older Adults 
The purpose of this study was to assess the feasibility of a standardized test of gaze stabilization as an indicator of vestibular function in community-dwelling older adults and to examine the relationship between gaze stabilization and physical performance.
Descriptive, Cross-sectional.
Tertiary Medical Center.
Eighty-six healthy older adults (22 males) of mean (SD) age 76.8 (5.8) years were recruited from the Pittsburgh community.
Main Outcome Measures
Performance on the gaze stabilization test (GST), measures of physical performance (standing balance, chair rises, and gait speed individually and combined into the Short Physical Performance Battery (SPPB)) and self-reported balance.
While over 90% of participants completed testing in the pitch and yaw planes, only 85% (73/86) had interpretable scores, due to prolonged perception time, independent of VOR. The mean (SD) head movement velocity in the pitch plane was 94.5 (26.7) degrees per second and in the yaw plane was 95.5 (29.3) degrees per second. There was a strong association between age and GST performance in the pitch and yaw planes (r=0.68, p<0.001). Poor GST performance in the yaw plane was associated with balance capacity with eyes closed. Additionally, there was a trend toward an association between self-reported balance and GST performance in both pitch (p=0.08) and yaw planes (p=0.10).
While most older adults completed GST testing, estimates were not interpretable in almost 15% due to prolonged perception time. GST in the yaw plane was worse than previously reported in healthy older adults and was associated with poor ability to balance with eyes closed. Self-reported balance tended to be associated with an objective assessment of VOR in this population of older adults.
PMCID: PMC2829936  PMID: 19940791
13.  Exercise, Inflammation and Aging 
Aging and Disease  2011;3(1):130-140.
Aging results in chronic low grade inflammation that is associated with increased risk for disease, poor physical functioning and mortality. Strategies that reduce age-related inflammation may improve the quality of life in older adults. Regular exercise is recommended for older people for a variety of reasons including increasing muscle mass and reducing risk for chronic diseases of the heart and metabolic systems. Only recently has exercise been examined in the context of inflammation. This review will highlight key randomized clinical trial evidence regarding the influence of exercise training on inflammatory biomarkers in the elderly. Potential mechanisms will be presented that might explain why exercise may exert an anti-inflammatory effect.
PMCID: PMC3320801  PMID: 22500274
Aging; Exercise, Inflammation; Adipose; Elderly
14.  The Feasibility of Inpatient Geriatric Assessment for Older Adults Receiving Induction Chemotherapy for Acute Myelogenous Leukemia 
To test the feasibility and utility of a bedside geriatric assessment (GA) to detect impairment in multiple geriatric domains in older adults initiating chemotherapy for acute myelogenous leukemia (AML).
Prospective observational cohort study.
Single academic institution.
Individuals aged 60 and older with newly diagnosed AML and planned chemotherapy.
Bedside GA was performed during inpatient exmination for AML. GA measures included the modified Mini-Mental State Examination; Center for Epidemiologic Studies Depression Scale; Distress Thermometer, Pepper Assessment Tool for Disability (includes self- reported activities of daily living (ADLs), instrumental ADLs, and mobility questions); Short Physical Performance Battery (includes timed 4-m walk, chair stands, standing balance); grip strength, and Hematopoietic Cell Transplantation Comorbidity Index.
Of 54 participants (mean age 70.8 ± 6.4) eligible for this analysis, 92.6% completed the entire GA battery (mean time 44.0 ± 14 minutes). The following impairments were detected: cognitive impairment, 31.5%; depression, 38.9%; distress, 53.7%; impairment in ADLs, 48.2%; impaired physical performance, 53.7%; and comorbidity, 46.3%. Most were impaired in one (92.6%) or more (63%) functional domains. For the 38 participants rated as having good performance status according to standard oncologic assessment (Eastern Cooperative Oncology Performance Scale score ≤1), impairments in individual GA measures ranged from 23.7% to 50%. Significant variability in cognitive, emotional, and physical status was detected even after stratification according to tumor biology (cytogenetic risk group classification).
Inpatient GA was feasible and added new information to standard oncology assessment, which may be important for stratifying therapeutic risk in older adults with AML.
PMCID: PMC3782375  PMID: 22091497
geriatric assessment; acute myelogenous leukemia; cancer; functional status; elderly
15.  Education-related differences in physical performance after age 60: a cross-sectional study assessing variation by age, gender and occupation 
BMC Public Health  2013;13:641.
Having a low level of education has been associated with worse physical performance. However, it is unclear whether this association varies by age, gender or the occupational categories of manual and non-manual work. This study examined whether there are education-related differences across four dimensions of physical performance by age, gender or occupational class and to what extent chronic diseases and lifestyle-related factors may explain such differences.
Participants were a random sample of 3212 people, 60 years and older, both living in their own homes and in institutions, from the Swedish National Study on Aging and Care, in Kungsholmen, Stockholm. Trained nurses assessed physical performance in grip strength, walking speed, balance and chair stands, and gathered data on education, occupation and lifestyle-related factors, such as physical exercise, body mass index, smoking and alcohol consumption. Diagnoses of chronic diseases were made by the examining physician.
Censored normal regression analyses showed that persons with university education had better grip strength, balance, chair stand time and walking speed than people with elementary school education. The differences in balance and walking speed remained statistically significant (p < 0.05) after adjustment for chronic diseases and lifestyle. However, age-stratified analyses revealed that the differences were no longer statistically significant in advanced age (80+ years). Gender-stratified analyses revealed that women with university education had significantly better grip strength, balance and walking speed compared to women with elementary school education and men with university education had significantly better chair stands and walking speed compared to men with elementary school education in multivariate adjusted models. Further analyses stratified by gender and occupational class suggested that the education-related difference in grip strength was only evident among female manual workers, while the difference in balance and walking speed was only evident among female and male non-manual workers, respectively.
Higher education was associated with better lower extremity performance in people aged 60 to 80, but not in advanced age (80+ years). Our results indicate that higher education is associated with better grip strength among female manual workers and with better balance and walking speed among female and male non-manual workers, respectively.
PMCID: PMC3733740  PMID: 23842209
Educational status; Aging; Chronic diseases; Muscle strength; Walking; Postural balance
16.  Association between Sleep and Physical Function in Older Men: The MrOS Sleep Study 
Determine whether sleep quality is associated with physical function in older men.
Six U.S. centers
2,862 community dwelling men
Total hours of nighttime sleep [TST], wake after sleep onset [WASO], sleep latency [SL], and sleep efficiency [SE] measured by actigraphy. Sleep stage distribution, respiratory disturbance index (RDI) and hypoxia measured by polysomnography. Measures of physical function including grip strength, walking speed, chair stand and narrow walk were obtained.
In age adjusted models, TST, SE<80%, WASO > 90 min, RDI > 30 and hypoxia were associated with physical function (i.e. mean grip strength was 2.9% and the mean walking speed was 4.3% lower in men with WASO > 90 minutes compared to men with WASO <90 minutes). After adjusting for potential covariates, differences in grip strength and walking speed remained significantly associated with WASO > 90 min, SE < 80% and hypoxia, but not with TST or RDI > 30.
Increased sleep fragmentation and hypoxia is associated with poorer physical function in older men.
PMCID: PMC2631084  PMID: 18759758
sleep; physical function; older men
17.  Obesity, but not undiagnosed airflow obstruction, is linked to respiratory symptoms and decreased functional capacity in adults without established COPD 
To delineate the relationship of obesity to airflow obstruction (AO) and respiratory symptoms in adults without a previous diagnosis of chronic obstructive pulmonary disease (COPD).
We analyzed data for potential referents recruited to be healthy controls for an ongoing study of COPD. The potential referents had no prior diagnosis of COPD or healthcare utilization attributed to COPD in the 12 months prior to recruitment. Subjects completed a structured interview and a clinical assessment including body mass index, spirometry, Six Minute Walk Test (SMWT) and the Short Performance Physical Battery (SPPB). We used multiple regression analyses to test the associations of obesity (BMI≥30kg/m2) and smoking with AO (FEV1/FVC ratio<0.7). We also tested the association of obesity with respiratory symptoms and impaired functional capacity (SPPB, SMWT), adjusting for AO.
Of 371 subjects (aged 40–65), 69 (19%) manifested AO. In multivariate analysis, smoking was positively associated with AO (per 10 pack-years, OR 1.24; 95% CI: 1.04 – 1.49), while obesity was negatively associated with AO (OR 0.54; 95% CI: 0.30 – 0.98). Obesity was associated with increased odds of reporting dyspnea on exertion (OR 3.6; 95% CI: 2.0 – 6.4), productive cough (OR 2.5; 95% CI: 1.1 – 6.0), and with decrements in SMWT distance (−67 ± 9meters; 95% CI: −84 to −50m) and SPPB score (OR 1.9; 95% CI: 1.1 – 3.5). None of these outcomes were associated with AO.
Although AO and obesity are both common among adults without an established COPD diagnosis, obesity, but not AO, is linked to a higher risk of reporting dyspnea on exertion, productive cough, and poorer functional capacity.
PMCID: PMC3523806  PMID: 22453663
airflow obstruction; obesity; functional status; health status; dyspnea
18.  Midlife Physical Activity and Mobility in Older Age 
Among older adults, loss of mobility represents a critical stage in the disablement process, whereby the risk for disability is significantly increased. Physical activity is a modifiable risk factor that is associated with reduced risk of losing mobility in older adulthood; however, few studies have examined physical activity performed earlier in life in relation to mobility later in life.
Data from a population-based study of 1155 adults aged 65 years and older living in the Chianti region of Italy in 1998–2000 were analyzed in 2005 and 2006. Participants retrospectively recalled their physical activity levels in midlife and underwent mobility testing and medical examination. Two objective mobility outcomes were examined as a function of past physical activity: the Short Physical Performance Battery (SPPB) and the ability to walk 400 meters.
Older Italian adults (mean age 74.8, standard deviation 7.3) who engaged in higher levels of physical activity in midlife were significantly more likely to perform better on the SPPB than individuals who were less physically active in midlife. In addition, failure to complete the 400-meter walk test was significantly less likely among physically active men (Level II) (odds ratio [OR]=0.37, 95% confidence interval [CI]=0.15–0.93) and very active men (Level III) (OR=0.23, 95% CI=0.09–0.63) when compared to men who were less active (Level I) in the past (p for trend, 0.008). These associations remained after adjustment for demographic factors, medical conditions, and physiologic impairments.
Older adults who reported higher levels of physical activity in midlife had better mobility in old age than less physically active ones.
PMCID: PMC2646092  PMID: 16905032
19.  Improving Physical Activity and Function in Overweight and Obese Older Adults with Osteoarthritis of the Knee: A Feasibility Study 
Osteoarthritis of the knee, a prevalent condition in older adults, can impact physical function and ability to perform physical activity. This randomized controlled trial examined the effects of a 6-month self-efficacy-based, individually delivered, lower-extremity exercise and fitness walking intervention with 6-month follow-up on physical activity and function. The 26 subjects were mostly older (M = 63.2 years, SD = 9.8), White (83%), obese (BMI M = 33.3, SD = 6.0) women (96%). Physical activity was measured by diaries. Physical function was measured by the 6-minute walk, Short Physical Performance Battery (SPPB), and WOMAC Physical Function subscale. Exercise self-efficacy was assessed by a questionnaire. Results showed significant increases in self-reported performance of lower-extremity exercise and participation in fitness walking, distance in the 6-minute walk, and SPPB scores from baseline to 6-month follow-up with a trend for improvement in self-efficacy. Results suggest that the intervention was feasible, acceptable, and improved physical activity and function.
PMCID: PMC3052988  PMID: 21290963
aged; exercise; functional limitations; osteoarthritis
20.  Measures of Physical Performance Capture the Excess Disability Associated With Hip Pain or Knee Pain in Older Persons 
Hip pain (HP) and knee pain (KP) may specifically affect function and performance; few studies investigate the functional impact of HP or KP in the same population.
Population-based sample of older individuals living in the Chianti area (Tuscany, Italy) (1998–2000); 1006 persons (564 women and 442 men) were included in this analysis; 11.9% reported HP and 22.4% reported KP in the past 4 weeks. Self-reported disability and lower extremity performance, measured by 400-m walk test and by the short physical performance battery (SPPB, including standing balance, chair raising, and 4-m walk test), were compared in participants reporting HP or KP versus those free of these conditions; the relationship of HP or KP with performance and self-reported disability was studied, adjusting for age, sex, hip or knee flexibility, muscle strength, multiple joint pain, major medical conditions, and depression.
Participants reporting HP were more likely to report disability in shopping, cutting toenails, carrying a shopping bag, and using public transportation; those with KP reported more disability in cutting toenails and carrying a shopping bag. Participants reporting HP or KP had significantly lower SPPB scores. Adjusting by SPPB, pain no longer predicted self-reported disability, except for “HP—carrying a shopping bag.”
In our cohort of older persons, those with HP reported disability in a wider range of activities than those with KP. Physical performance measured by SPPB was impaired in both conditions. Reduced lower extremity performance captures the excess disability associated with either HP or KP.
PMCID: PMC2773811  PMID: 19797345
Hip pain; Knee pain; Older persons; Performance; Disability
21.  Residual effects of muscle strength and muscle power training and detraining on physical function in community-dwelling prefrail older adults: a randomized controlled trial 
BMC Geriatrics  2012;12:68.
Although resistance exercise interventions have been shown to be beneficial in prefrail or frail older adults it remains unclear whether there are residual effects when the training is followed by a period of detraining. The aim of this study was to establish the sustainability of a muscle power or muscle strength training effect in prefrail older adults following training and detraining.
69 prefrail community-dwelling older adults, aged 65–94 years were randomly assigned into three groups: muscle strength training (ST), muscle power training (PT) or controls. The exercise interventions were performed for 60 minutes, twice a week over 12 weeks. Physical function (Short Physical Performance Battery=SPPB), muscle power (sit-to-stand transfer=STS), self-reported function (SF-LLFDI) and appendicular lean mass (aLM) were measured at baseline and at 12, 24 and 36 weeks after the start of the intervention.
For the SPPB, significant intervention effects were found at 12 weeks in both exercise groups (ST: p = 0.0047; PT: p = 0.0043). There were no statistically significant effects at 24 and 36 weeks. In the ST group, the SPPB declined continuously after stop of exercising whereas the PT group and controls remained unchanged. No effects were found for muscle power, SF-LLFDI and aLM.
The results showed that both intervention types are equally effective at 12 weeks but did not result in statistically significant residual effects when the training is followed by a period of detraining. The unchanged SPPB score at 24 and 36 weeks in the PT group indicates that muscle power training might be more beneficial than muscle strength training. However, more research is needed on the residual effects of both interventions. Taken the drop-out rates (PT: 33%, ST: 21%) into account, muscle power training should also be used more carefully in prefrail older adults.
Trial registration
This trial has been registered with (NCT00783159)
PMCID: PMC3538686  PMID: 23134737
Prefrailty; Exercise; Mobility; Residual effects; Detraining
22.  Activity in GEriatric acute CARe (AGECAR): rationale, design and methods 
BMC Geriatrics  2012;12:28.
The Activity in GEriatric acute CARe (AGECAR) is a randomised control trial to assess the effectiveness of an intrahospital strength and walk program during short hospital stays for improving functional capacity of patients aged 75 years or older.
Patients aged 75 years or older admitted for a short hospital stay (≤14 days) will be randomly assigned to either a usual care (control) group or an intervention (training) group. Participants allocated in the usual care group will receive normal hospital care and participants allocated in the intervention group will perform multiple sessions per day of lower limb strength training (standing from a seated position) and walking (10 min bouts) while hospitalized. The primary outcome to be assessed pre and post of the hospital stay will be functional capacity, using the Short Physical Performance Battery (SPPB), and time to walk 10 meters. Besides length of hospitalization, the secondary outcomes that will also be assessed at hospital admission and discharge will be pulmonary ventilation (forced expiratory volume in one second, FEV1) and peripheral oxygen saturation. The secondary outcomes that will be assessed by telephone interview three months after discharge will be mortality, number of falls since discharge, and ability to cope with activities of daily living (ADLs, using the Katz ADL score and Barthel ADL index).
Results will help to better understand the potential of regular physical activity during a short hospital stay for improving functional capacity in old patients. The increase in life expectancy has resulted in a large segment of the population being over 75 years of age and an increase in hospitalization of this same age group. This calls attention to health care systems and public health policymakers to focus on promoting methods to improve the functional capacity of this population.
Trial registration ID: NCT01374893.
PMCID: PMC3420239  PMID: 22682063
Randomised controlled trial; Ageing; Hospitalisation; Elderly; Intrahospital exercise; Functional capacity
23.  Functional Foot Symmetry and Its Relation to Lower Extremity Physical Performance in Older Adults: The Framingham Foot Study 
Journal of Biomechanics  2012;45(10):1796-1802.
While many studies use gait symmetry as a marker of healthy gait, the evidence that gait symmetry exists is limited. Because gait symmetry is thought to arise through laterality (i.e., limb preference) and affects gait retraining efforts, it is important to understand if symmetry exists during gait in older adults. Therefore, the purpose of this study was to evaluate foot and gait symmetry in the population-based Framingham Foot Study as well as to determine the effects of vertical force symmetry on physical performance measures.
Members of the Framingham Foot Study were included in this analysis (N=1333). Foot function and force data were collected using the Tekscan Matscan during self-selected gait, with symmetry evaluated using the symmetry index. The short physical performance battery (SPPB) measures of balance, chair stands and gait speed assessed lower extremity physical function. Participants were evaluated using quartiles of gait speed and foot symmetry to determine the effects of symmetry on lower extremity physical function.
Individuals with faster gait speed displayed greater foot function asymmetry; individuals with −3.0% to −9.5% asymmetry in foot function performed better on the short physical performance battery (SPPB). Further, with aging, the degree of asymmetry was reduced.
While this research suggests that a moderate degree of foot asymmetry is associated with better lower extremity function, the causes of vertical force asymmetry are unknown. Future studies should evaluate the causes of foot asymmetry and should track the changes in symmetry that occur with aging.
PMCID: PMC3376228  PMID: 22560642
foot function; functional asymmetry; physical performance; lower extremity
24.  Physical function and self-rated health status as predictors of mortality: results from longitudinal analysis in the ilSIRENTE study 
BMC Geriatrics  2008;8:34.
Physical function measures have been shown to predict negative health-related events in older persons, including mortality. These markers of functioning may interact with the self-rated health (SRH) in the prediction of events. Aim of the present study is to compare the predictive value for mortality of measures of physical function and SRH status, and test their possible interactions.
Data are from 335 older persons aged ≥ 80 years (mean age 85.6 years) enrolled in the "Invecchiamento e Longevità nel Sirente" (ilSIRENTE) study. The predictive values for mortality of 4-meter walk test, Short Physical Performance Battery (SPPB), hand grip strength, Activities of Daily Living (ADL) scale, Instrumental ADL (IADL) scale, and a SRH scale were compared using proportional hazard models. Kaplan-Meier survival curves for mortality and Receiver Operating Characteristic (ROC) curve analyses were also computed to estimate the predictive value of the independent variables of interest for mortality (alone and in combination).
During the 24-month follow-up (mean 1.8 years), 71 (21.2%) events occurred in the study sample. All the tested variables were able to significantly predict mortality. No significant interaction was reported between physical function measures and SRH. The SPPB score was the strongest predictor of overall mortality after adjustment for potential confounders (per SD increase; HR 0.64; 95%CI 0.48–0.86). A similar predictive value was showed by the SRH (per SD increase; HR 0.76; 95%CI 0.59–0.97). The chair stand test was the SPPB subtask showing the highest prognostic value.
All the tested measures are able to predict mortality with different extents, but strongest results were obtained from the SPPB and the SRH. The chair stand test may be as useful as the complete SPPB in estimating the mortality risk.
PMCID: PMC2628909  PMID: 19102751
25.  The physical capability of community-based men and women from a British cohort: the European Prospective Investigation into Cancer (EPIC)-Norfolk study 
BMC Geriatrics  2013;13:93.
The European Working Group for Sarcopenia in Older People (EWGSOP) published a case-finding algorithm for sarcopenia, recommending muscle mass measurement in older adults with low grip strength (women <20 kg; men <30 kg) or slow walking speed (≤0.8 m/s). However, the implications of adopting this algorithm into clinical practice are unclear. Therefore, we aimed to explore the physical capability of men and women from a British population-based cohort study.
In the European Prospective Investigation into Cancer-Norfolk study, 8,623 community-based adults (48-92 years old) underwent assessment of grip strength, walking speed, timed chair stands and standing balance. The proportion of older men and women (≥65 years) fulfilling EWGSOP criteria for muscle mass measurement was estimated. Additionally, cross-sectional associations of physical capability with age and sex were explored using linear and logistic regression.
Approximately 1 in 4 older participants (28.8%) fulfilled criteria for muscle mass measurement with a greater proportion of women than men falling below threshold criteria (33.6% versus 23.6%). Even after adjustment for anthropometry, women were 12.4 kg (95% Confidence Interval [CI] 12.0, 12.7) weaker, took 12.0% (95% CI 10.0, 14.0) longer to perform five chair stands and were 1.82 (95% CI 1.48, 2.23) times more likely to be unable to hold a tandem stand for 10 seconds than men, although usual walking speed was similar. Physical capability was inversely associated with age and per year, walking speed decreased by 0.01 m/s (95% CI 0.01, 0.01) and grip strength decreased by 0.49 kg (men; 95% CI 0.46, 0.51) and 0.25 kg (women; 95% CI 0.23, 0.27). Despite this, there was still variation within age-groups and not all older people had low physical capability.
Every effort to optimise functional health in later life should be made since poor function is not inevitable. However, if the EWGSOP sarcopenia case-finding algorithm is endorsed, large proportions of older people could qualify for muscle mass measurement which is not commonly available. Considering population ageing, further discussion is needed over the utility of muscle mass measurement in clinical practice.
PMCID: PMC3846689  PMID: 24020915
Ag(e)ing; Sarcopenia; Hand strength; Physical capability; Sex factors

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