Nutrition and Physical Activity Clinical Practice Guidelines for Older Adults Living with Frailty.

BACKGROUND: We developed clinical practice guidelines to provide health care providers with evidence-based recommendations for decisions related to the effective management of frailty and pre-frailty using nutrition and physical activity interventions. METHODS: We based the recommendations on two systematic reviews with meta-analyses. Nutrition, physical activity, and combined nutrition and physical activity interventions for adults ≥65y were considered if study populations were identified as frail using a frailty tool or assessment. Risk of bias and certainty of evidence were evaluated. We included physical outcomes, mobility, frailty, cognitive function, activities of daily living, falls, quality of life, diet quality, energy/fatigue levels, health services use, and caregiver outcomes. RESULTS: Overall, mobility improvements were moderate with nutritional strategies that optimize dietary intake, various types of physical activity interventions, and interventions that combine nutrition and physical activity. Physical outcomes, such as body mass and muscle strength, improved moderately with nutritional strategies and interventions that combined nutrition with physical activity. Frailty status improved with multi-component physical activity interventions. Strong recommendations include optimizing dietary intake, performing physical activity, and adopting interventions that combine nutrition and physical activity. We strongly recommend various types of physical activity including muscle strengthening activities, mobilization or rehabilitation exercises, and multi-component physical activity interventions. INTERPRETATION: Tailored nutrition and physical activity interventions based on individual goals and health status are associated with improved clinical and physical outcomes. While the recommendations facilitate shared decision-making, we identified sparse application of validated frailty assessments and lack of standardized research outcomes as critical gaps in knowledge.

Muscle analysis using pQCT, DXA and MRI.

Skeletal muscle is one of the larger organs of the body and is integrally involved in metabolic processes in both health and disease. The ability to accurately and precisely measure skeletal muscle structure is essential for understanding the changes that occur naturally over the lifespan as well as those observed in chronic disease, and in response to targeted interventions. Musculoskeletal imaging allows for the quantification of skeletal muscle mass and select modalities are also able to determine muscle quality. The purpose of this paper is to review peripheral quantitative computed tomography (pQCT), dual X-ray energy absorptiometry (DXA) and magnetic resonance imaging (MRI) techniques used to assess skeletal muscle size and quality in-vivo. Each modality is briefly described and the strengths and limitations are provided. No single imaging technique will be able to best address every clinical and research question of interest. Selecting the most appropriate imaging device for measuring skeletal muscle depends on access to technology, availability of expertise required for image acquisition and analysis, characteristics of the population, anatomical site of interest, and the level of structural detail required.

Inclinometer-based measures of standing posture in older adults with low bone mass are reliable and associated with self-reported, but not performance-based, physical function.

UNLABELLED: The association between posture and physical function during daily activities in people at risk for osteoporotic fracture is not clear. We report the reliability of measuring posture using the digital inclinometer and how these measures relate to performance-based and self-reported physical function. INTRODUCTION: This study aims to determine the reliability of a simple clinical method for assessing spine curvatures in people with low bone mass and the association between spine curvature measures and pain, physical function (mobility/activities of daily living (ADL)) and quality of life. METHODS: One rater assessed 36 high-functioning adults, aged 52-82 years, attending an outpatient osteoporosis clinic. A digital inclinometer was used to measure lumbosacral angle (S), lumbar standing posture (L), and thoracic standing posture (T) and ADL performance was assessed using the short form of the Safe Functional Motion test (SFM-6), on two occasions approximately 8.7 days apart. Participants reported average pain intensity over the past week and completed the Timed Up and Go test (TUGT) and the mini-Osteoporosis Quality of Life questionnaire (mini-OQLQ). Acceptable reliability was determined using the intraclass correlation coefficient (ICC). Associations were determined using Pearson's correlation coefficients (r) (and Spearman's rho (r s), for non-normal data). RESULTS: ICC (95 % CI) for S, L, and T = 0.91 (0.82, 0.95), 0.90 (0.82, 0.95), and 0.91 (0.84, 0.95), respectively, for test-retest reliability. Thoracic standing posture was associated with the ADL domain of the mini-OQLQ (r s = -0.39) and the TUGT (r = 0.42). Standing posture was not related to pain or total SFM-6 score. CONCLUSIONS: Digital inclinometer measures provide a quick highly reliable, valid, direct assessment of kyphosis. Use of these measures in the clinical setting is expected to facilitate identification and effective management of postural impairments (e.g., trunk extensor muscle weakness, vertebral fracture) associated with osteoporosis.

Efficacy of low frequency pulsed subsensory threshold electrical stimulation vs placebo on pain and physical function in people with knee osteoarthritis: systematic review with meta-analysis.

OBJECTIVE: To determine if low frequency (≤100 Hz) pulsed subsensory threshold electrical stimulation produced either through pulsed electromagnetic field (PEMF) or pulsed electrical stimulation (PES) vs sham PEMF/PES intervention is effective in improving pain and physical function at treatment completion in adults with knee osteoarthritis (OA) blinded to treatment. METHOD: The relevant studies were identified by searching eight electronic databases and hand search of the past systematic reviews on the same topic till April 5, 2012. We included randomized controlled trials (RCTs) of people with knee OA comparing the outcomes of interest for those receiving PEMF/PES with those receiving sham PEMF/PES. Two reviewers independently selected studies, extracted relevant data and assessed quality. Pooled analyses were conducted using inverse-variance random effects models and standardized mean difference (SMD) for the primary outcomes. RESULTS: Seven small trials (459 participants/knees) were included. PEMF/PES improves physical function (SMD = 0.22, 95% confidence interval (CI) = 0.04, 0.41, P = 0.02, I(2) = 0%), and does not reduce pain (SMD = 0.08, 95% CI = -0.17, 0.32, P = 0.55, I(2) = 43%). The strength of the body of evidence was low for physical function and very low for pain. CONCLUSION: Current evidence of low and very low quality suggests that low frequency (≤100 Hz) pulsed subsensory threshold electrical stimulation produced either through PEMF/PES vs sham PEMF/PES is effective in improving physical function but not pain intensity at treatment completion in adults with knee OA blinded to treatment. Methodologically rigorous and adequately powered RCTs are needed to confirm the findings of this review.

Muscle cross sectional area and grip torque contraction types are similarly related to pQCT derived bone strength indices in the radii of older healthy adults.

OBJECTIVES: We sought to identify the variance in radius bone strength indices explained by forearm muscle cross sectional area (MCSA) and isometric (ISO), concentric (CON), or eccentric (ECC) grip torque in healthy men and postmenopausal women when gender and body size were controlled for. Additionally we assessed variance in various grip contractions explained by MCSA. METHODS: pQCT estimated bone strength of the radius and forearm MCSA were measured from 45 healthy adults (59.4-/+7.2 yrs). Isokinetic dynamometry was used to assess peak grip torque. Regressions were adjusted for gender and radius length. RESULTS: Peak grip torques were not independent predictors (p>0.05) of distal radius bone strength in compression (bone strength index; BSI(c)) when gender was included in the prediction model. Gender was not a contributor to any model that included MCSA (p>0.05). At the diaphysis all torque measures, MCSA, gender, and length, significantly contributed to predict similar portions (79-80%) of the stress strain index (SSI(p); strength in torsion). MCSA accounted for 68-76% of variance in grip torque (p<0.05). CONCLUSIONS: When estimating radius bone strength, forearm MCSA is a comparable predictor to CON, ISO, and ECC grip torques and is also a good surrogate of these contraction types.