Differential Factors Are Associated with Physical Activity in Older Adults in Brazil with and without Non-Communicable Chronic Diseases: A Cross-Sectional Analysis of the 2019 National Health Survey.

This study analyzed whether sociodemographic factors, health perception, dietary habits, and screen time are related to physical activity (PA) in older people with and without non-communicable chronic diseases (NCDs). This cross-sectional study analyzed data from the 2019 Brazilian National Health Survey; the sample was older adults (≥60 years old; n = 22,726). The outcome of this study was being physically active or inactive during leisure time, and NCD was used as a moderating variable. The correlates investigated were sociodemographic and health-related variables. According to the logistic regression analysis, it was observed that being male had an association only in the group with NCDs (OR = 1.25 (1.05-1.48)), as well as residing in the northeastern region (OR = 1.26 (1.04-1.53)). On the other hand, high levels of education (OR = 4.09 (2.92-5.2); OR = 1.92 (1.48-2.49)) and income (OR = 1.64 (1.09-2.48); OR = 1.86 (1.33-2.60)) were associated with PA in both groups, as well as dietary habits (OR = 1.03 (1.01-1.05); (OR = 1.05 (1.04-1.07)). Advanced age (OR = 0.96 (0.94-0.97); OR = 0.97 (0.96-0.98)) and reporting a regular health perception (OR = 0.53 (0.43-0.66); OR = 0.61 (0.52-0.73)) were factors associated with physical inactivity in both groups. Gender, education, and income were unequally associated with an active lifestyle in both groups, and therefore, barriers to PA may arise.

Frailty, physical fitness and quality of life: a comparison between physically frail and robust older women / Fragilidad, aptitud física y calidad de vida: comparación entre personas de la tercera edad frágiles y robustas físicamente / Fragilidade, aptidão física e qualidade de vida: uma comparação entre idosas fisicamente frágeis e robustas

OBJECTIVE: The aim of the study was to compare physical fitness, quality of life and domains of frailty between physically frail and robust older women, whose was classified by the physical domain from Kihon Checklist. METHOD: One hundred and thirty-two community-dwelling older women participated in the study (68.5 +/- 6.1 years). Data were collected through questionnaires (sociodemographic, Kihon Checklist, Short Form-8 items) and physical and functional tests. RESULTS: Most frail older women lived alone (P<0.01), had lower frequency of leaving home weekly (P<0.03) and reported a greater history of fall events compared to the robust ones (P<0.01). In addition, physically frail older women presented lower performance in handgrip strength, walking speed usual and maximum, and Timed Up and Go. In addition, they had worst results in other domains of frailty (i.e., instrumental activities of daily living, oral condition, socialization, cognition) as well as a lower quality of life. Older women leaving home in a lower frequency and living alone may present an increase of emotional issues and, occasionally, a decrease of the quality of life. CONCLUSION: Physical frail older women leaving home less present lower muscle strength and power and, a combination of frailties besides the physical one

OBJETIVO: Comparar la aptitud física, la calidad de vida y los dominios de fragilidad entre ancianos físicamente frágiles y robustos, clasificados por el dominio físico del Kihon Checklist. MÉTODO: Mujeres ancianas de la comunidad participaron del estudio (n=132; 68.5 +/- 6.1 años). Los datos fueron recolectados por medio de cuestionarios (sociodemográfico, Kihon Checklist, Short Form-8) y pruebas físicas y funcionales. RESULTADOS: La mayoría de las ancianas frágiles vivían solas (P <0.01), presentaron menor frecuencia para salir de casa semanalmente (P <0.03) y sufrieron mayor número de caídas en comparación a las robustas (P <0.01). Las personas de edad avanzada físicamente frágiles presentaron un menor desempeño en la fuerza de prensión manual, velocidad de caminata usual y máxima y en el test Timed Up and Go. Además, presentaron resultados peores en otros ámbitos de fragilidad (actividades instrumentales de la vida diaria, condición oral, socialización, cognición), así como una menor calidad de vida. Las ancianas que salen de casa con menor frecuencia y viven solas pueden presentar un aumento de problemas emocionales y, ocasionalmente, una disminución de la calidad de vida. CONCLUSIÓN: Ancianas físicamente frágiles, que salen menos de casa, presentan menor fuerza y potencia muscular junto a otros ámbitos de fragilidad

OBJETIVO: O objetivo do estudo foi comparar a aptidão física, qualidade de vida e os domínios de fragilidade entre idosas fisicamente frágeis e robustas, classificadas pelo dominio físico do Kihon Checklist. MÉTODO: Cento e trinta e duas idosas da comunidade participaram do estudo (68.5 +/- 6.1 anos). Os dados foram coletados por meio de questionários (sociodemográfico, Kihon Checklist, Short Form-8) e testes físicos e funcionais. RESULTADOS: A maioria das idosas frágeis moravam sozinhas (P <0.01), apresentaram menor frequência ao sair de casa semanalmente (P <0.03) e relataram maior histórico de quedas em comparação às robustas (P <0.01). Além disso, as idosas fisicamente frágeis apresentaram menor desempenho na força de preensão manual, velocidade de caminhada usual e máxima, Timed Up and Go. Em adição a isto, apresentaram resultados agravados em outros domínios da fragilidade (atividades instrumentais da vida diária, condição oral, socialização, cognição), bem como uma menor qualidade de vida. Idosas que saem de casa com menor frequência e moram sozinhas podem apresentar um acréscimo de problemas emocionais e, ocasionalmente, uma diminuição da qualidade de vida. CONCLUSÃO: Idosas físicamente frágeis, que saem menos de casa, apresentam menor força e potência muscular, e uma combinação do domínio físico com outros domínios da fragilidade

Periodized and non-periodized resistance training programs on body composition and physical function of older women.

BACKGROUND AND PURPOSE: Although combining classical resistance (RT) and power training (PT) might be an efficient strategy to achieve optimal enhancements in body composition and physical function in older adults, the most effective approach to combine these different types of exercise training is still unknown. Periodization, an organizational model that refers to a succession of cycle that will vary in exercise intensity and/or volume to allow for the training stimulus to remain biologically challenging and effective, may represent an interesting approach. Among the different types of periodization, daily undulating periodization (DUP) has attracted considerable attention given its superiority in comparison to nonperiodized (NP) RT programs to elicit neuromuscular improvements in young adults. However, whether a DUP program combining PT and traditional RT can produce similar or greater improvements in body composition and physical function in older adults than a NP RT program has not yet been established. Therefore, the present study compared the effects of a DUP and NP programs on body composition and physical function in healthy community-dwelling older women. METHODS: Forty-two older women (60-79 years) were randomized into one of the three experimental groups: NP, DUP, and control group (CG). Body composition and physical function were assessed at baseline and after the intervention. The sessions of exercises were performed twice a week over 22 weeks. In NP, the two exercise sessions were based on three sets of 8-10 repetitions at a "difficult" intensity (i.e., 5-6) prescribed based on the Rating of Perceived Exertion (RPE) scale. In DUP, the first session was based on PT (three sets of 8-10 repetitions at a "moderate" intensity, i.e., 3, performed as fast as possible), while the second session was similar to the NP. RESULTS: There were no significant changes in body composition in any of the groups. Relative to baseline, participants assigned to NP showed significant improvements in countermovement jump (+55.7%), timed "Up and Go" (TUG) test (-43.2%, faster), walking speed (+12.0%), and one-leg-stand (+154.5%). In contrast, DUP only improved TUG performance (-53.2%, faster). CONCLUSION: NP and DUP improved physical function in community-dwelling older women, with greater improvements in physical parameters only observed after NP.

Influence of ischemic stroke on the frailty process of older adults / Influencia del accidente cerebrovascular isquémico en el proceso de fragilidad en adultos mayores

Abstract Introduction: Older adults may become fragile by different mechanisms that influence homeostasis, such as stroke. Objective: To investigate the relation of stroke with the frailty process in older adults, correlating body mass index, functional aspects and resulting deficits. Methods: A case-control study was performed between February and November 2015. Patients aged 60 years and older, who had suffered ischemic stroke, were evaluated using the Kihon Checklist (KCL), the modified Rankin Scale, and the National Institutes of Health Stroke Scale. Baseline data included pre-stroke information and follow-up data obtained one month after discharge. The statistical analysis was performed by paired t-test and Friedman non-parametric test. Results: The study was conducted on 16 older adults (72.19±7.20 years old), making evident the influence of stroke on the frailty process (p<0.005). After stroke, an increase was observed in the mean scores domains: total KCL score (p=0.001); instrumental activities of daily living (p=0.001); physical (p=0.002); socialization (p=0.006); mood (p=0.004). Conclusions: A significant worsening of frailty was observed after stroke. KCL was satisfactory to evaluate frailty pre and post-stroke due to its applicability and coverage of the main aspects of frailty in older adults.

Resumen Introducción. Los ancianos pueden tornarse frágiles por diferentes mecanismos que influencian la homeostasis, como por ejemplo el accidente cerebrovascular (ACV). Objetivo. Investigar la relación del ACV con el proceso de fragilización en correlación con el índice de masa corporal, la funcionalidad y los déficits resultantes. Materiales y métodos. Se realizó un estudio de caso-control. Se incluyeron pacientes con 60 años o más que sufrieron ACV isquémico y evaluados con Kihon Checklist (KCL), Escala de Rankin Modificada y Evaluación Neurológica del National Institutes of Health Stroke Scale. Se recogieron datos de baseline de información pre-ACV y de follow-up un mes después del alta hospitalaria. El análisis estadístico se realizó mediante prueba t pareada y prueba non paramétrica de Friedman. Resultados. Se incluyeran 16 ancianos (720.19±7.20 años) y se observó la influencia del ACV en la fragilización (p<0.005). Aumentaron las puntuaciones de los dominios: KCL total (p=0.001); actividades instrumentales de la vida diária (p=0.001); físico (p=0.002); socialización (p=0.006); humor (p=0.004). Conclusiones. Se observó empeoramiento de la fragilidad después del ACV. El KCL se presentó como una evaluación satisfactoria para medir la fragilidad pre y post ACV debido a su aplicabilidad y cobertura de los aspectos principales de la fragilidad en ancianos.

Systematic review of the Kihon Checklist: Is it a reliable assessment of frailty?

AIM: To investigate whether the Kihon Checklist (KCL) can predict frailty and disability. METHODS: The studies analyzed for the present review were retrieved by searching electronic databases and other sources using the keywords "Kihon Checklist" and "Basic Checklist." The articles were restricted to those written in English and published in health sciences journals from the year 2006 until the end of April 2015. To be included in the full analysis, the study had to be primary research and use the KCL as a dependent or independent variable. RESULTS: A total of 62 articles were identified in the initial search, and after screening, 13 articles were included in this review. The KCL was found to be closely correlated with validated assessments of frailty phenotypes. The complete version of the KCL and specific domains have been used as research outcomes to verify frailty in cross-sectional and longitudinal studies. KCL domains were applied to evaluate different outcomes, such as depressive mood, functional disability and instrumental activities of daily living limitations. CONCLUSIONS: The KCL is a reliable tool for predicting general frailty and frailty aspects in older adults. The KCL was shown to be adequate for cross-cultural studies and to be suitable for addressing frailty demands among elderly in multiple cohorts. The KCL is a short questionnaire, which makes its administration by health promoters easy; thus, it has been used to evaluate the effectiveness of frailty interventions. We strongly recommend use of the KCL in community and clinical practice to assess frailty status. Geriatr Gerontol Int 2016; 16: 893-902.

Differences in lifestyle, physical performance and quality of life between frail and robust Brazilian community-dwelling elderly women.

AIM: To investigate the lifestyles, physical performance and quality of life (QOL) of frail and robust Brazilian community-dwelling older women, and to identify risk factors for frailty. METHODS: Frailty was assessed using the Kihon Checklist. Lifestyles were assessed using a questionnaire. Physical performance was assessed by measuring walking speeds, performance on the one-leg stand test and the five-times chair stand test and handgrip strength. QOL was assessed using the Short Form-8 questionnaire. Participants were divided into frail and robust groups based on their total Kihon Checklist scores. RESULTS: A total of 109 participants (age 70.8 ± 6.87 years) were included in this study (robust n = 85, frail n = 24). Differences in living structures (P < 0.001), financial satisfaction (P = 0.004) and the frequencies with which participants leave the house (P < 0.001) were found between groups. The frail group had more fallers (P = 0.047), and lower engagement in physical activity (P = 0.044), lower body mass indices (P = 0.043) and poorer nutritional status (P = 0.002), whereas robust older people showed better physical performance (walking speed P < 0.001, one-leg stand P = 0.021, handgrip strength P = 0.002) and higher QOL scores (general health P = 0.005, role-physical P = 0.013, bodily pain P = 0.002, vitality P = 0.001, social functioning P = 0.001, role-emotional P = 0.008). Multivariate regression analysis identified a slow usual walking speed and bodily pain as risk factors for frailty. CONCLUSIONS: Frail participants had higher indices for being housebound, and having financial dissatisfaction, a sedentary lifestyle, falls, and malnutrition. Furthermore, they showed poorer physical performance and QOL. An early, well-focused approach is crucial, especially for older adults who walk slowly and have bodily pain to preserve health and QOL. Geriatr Gerontol Int 2016; 16: 829-835.

Arterial stiffness is associated with low skeletal muscle mass in Japanese community-dwelling older adults.

AIM: To examine whether arterial stiffness, measured by the cardio-ankle vascular index (CAVI), is associated with skeletal muscle mass index (SMI) in Japanese community-dwelling older adults. METHODS: Data were collected from 175 participants through questionnaires and specific tests; the data included demographic, lifestyle and health characteristics, body mass index (BMI), and body composition features determined by the bioelectrical impedance analysis, ankle-brachial index, the Mini-Nutritional Assessment, handgrip strength (GS), walking speed and shuttle walking tests (SW), and arterial stiffness determined by the CAVI. Absolute SMI was dichotomized according to the first quintile, which determined low (n = 35) and normal (n = 140) SMI. RESULTS: Participants with low SMI were older (P = 0.01), had more polypharmacy (P = 0.01), a lower BMI (P < 0.001), and fat mass index (P = 0.02), and had a greater risk of malnutrition (P < 0.001) than the normal group. Additionally, they showed poorer physical performance (GS and SW, P = 0.007 and 0.01, respectively) than the normal group. Furthermore, CAVI was associated with SMI even after adjustments (OR 1.82, 95% CI 1.14-2.90, P = 0.01). CONCLUSIONS: Our data showed that arterial stiffness is associated with low SMI in community-dwelling older adults, even when adjusting by multiple factors, showing a close interaction of vascular aging and muscle mass decline.

Self-reported quality of sleep is associated with bodily pain, vitality and cognitive impairment in Japanese older adults.

AIM: Poor sleep can affect physical and mental health, and consequently people's quality of life (QOL); however, only a few studies have addressed the potential associations of physical and mental health with quality of sleep (QOS) in Japan. The present study aimed to investigate the association of QOS with sociodemographic and lifestyle characteristics, cognitive status, nutrition, depression, seclusion, and QOL in Japanese community-dwelling older adults. METHODS: Data were collected through self-administered questionnaires and other specific tests in 145 (age 73 years [range 70-77 years]) participants. The χ(2) -test or Fisher's exact test were used to compare categorical variables stratified by QOS, and the Mann-Whitney U-test was used for continuous variables. Furthermore, logistic regression analyses were carried out to verify the associations with QOS. RESULTS: The poor QOS group had more males (P < 0.05), a shorter self-reported sleep duration (P < 0.001), higher body mass index (P < 0.05) and higher risk of depression (P < 0.05), whereas the good QOS group showed higher scores in the QOL summary and domains of physical component (P < 0.01), general health (P < 0.001), bodily pain (P < 0.001) and vitality (P < 0.001). In the logistic regression model, cognitive status (OR 0.13, 95% CI 0.03-0.55), bodily pain (OR 0.91, 95% CI 0.84-1.00) and vitality (OR 0.82, 95% CI 0.73-0.92) were associated with QOS. CONCLUSION: The present study provides evidence that QOS is linked to cognitive status, bodily pain and vitality in Japanese older adults. We maintain that screening a person's sleep characteristics in a community setting might be relevant to identify those older adults at risk of a poor QOL and frailty in the early phase, triggering further health analyses.

Validation and translation of the Kihon Checklist (frailty index) into Brazilian Portuguese.

AIM: To translate the Japanese Kihon Checklist (frailty index) into the Portuguese language, and to validate the use of the checklist for the assessment of the elderly Brazilian population. METHODS: A semantic analysis was carried out, along with pretesting of bilingual participants. The checklist was validated against the Edmonton Frail Scale. RESULTS: A total of 188 Brazilian older adults (mean age 69.5 ± 7.47 years) participated in the present study. In the semantic analysis, six elderly participants reported no difficulty with responding to the Portuguese version of the Kihon Checklist. During pretesting with 21 bilingual participants, we found a strong correlation between the total scores of the original version of the Kihon Checklist in Japanese and the translated version in Portuguese (r = 0.764, P < 0.001). According to the validation process, which involved 161 participants, there was a significant correlation between the total scores of the Kihon Checklist and the Edmonton Frail Scale (r = 0.535, P < 0.001), and between each domain of the checklist with the total score of Edmonton Frail Scale (lifestyle τ = 0.429, P < 0.001; physical strength τ = 0.367, P < 0.001; nutrition τ = 0.211, P = 0.002; eating τ = 0.213, P = 0.001; socialization τ = 0.269, P < 0.001; memory τ = 0.285, P < 0.001; and mood τ = 0.359, P < 0.001). Furthermore, the Portuguese version of the Kihon Checklist showed satisfactory internal consistency (Cronbach's α coefficient: 0.787). CONCLUSIONS: The Portuguese language version of the Kihon Checklist presented good internal consistency and validity. Therefore, we encourage its application in the elderly Brazilian population with an aim of monitoring their frailty to prevent or delay the functional dependence and any other adverse health outcomes. [Correction added on 14 January 2013, after first online publication: the phrase 'loss of' has been deleted from the preceding statement.]