Intermuscular Adipose Tissue: A Brief Review of Etiology, Association With Physical Function and Weight Loss in Older Adults.

Adipose tissue redistributes during aging resulting in increased intermuscular adipose tissue (IMAT), intramuscular, and intramyocellular lipid while subcutaneous fat decreases. IMAT has been associated with lower muscle strength, power, and quality, chronic inflammation, impaired glucose tolerance, and elevated total cholesterol in older adults. This review focused on trials investigating the role of age, physical activity and diet on IMAT. The studies agreed that IMAT increases with age and seems to be responsive to physical activity, particularly the combination of aerobic and resistance exercise. However, some reported this could occur with or without weight loss, and some reported that high IMAT at baseline may blunt the muscle quality adaptive response to physical training. Larger and longer trials are needed to differentiate the independent or synergistic effects of resistance and/or aerobic training, and obesity and weight loss combined with resistance, aerobic or combination of aerobic and resistance training on IMAT.

Adding self-management of chronic conditions to fall prevention: A feasibility study.

OBJECTIVE: Assess feasibility and impact of adding a long-term condition self-management program (Living a Healthy Life, LHL) into Steady as You Go (SAYGO) fall prevention exercise classes. METHODS: Four-day LHL leader training workshop to deliver six weekly program. Focus groups explored feasibility and acceptability. Chronic disease self-efficacy, balance confidence, health behaviours and status were measured at 6 weeks, 3, 6 and 12 months. RESULTS: Four leaders and 17 participants volunteered. Focus groups revealed that becoming a leader was considered stressful. Participants valued discussions about managing health, strategies for better communication with doctors, keeping track of medications, action plans and nutrition labels. Between 6-week and 12-month follow-up, self-rated health increased. CONCLUSION: Although participants valued LHL information, the low participation rates, time commitment and stress of becoming a leader and leading classes suggest that adding LHL to other fall prevention programs will need further consideration around integration of the programs.

Fall-Related Injuries in a Cohort of Community-Dwelling Older Adults Attending Peer-Led Fall Prevention Exercise Classes.

BACKGROUND AND PURPOSE: To investigate reported injuries and circumstances and to estimate the costs related to falls experienced by older adults participating in Steady As You Go (SAYGO) peer-led fall prevention exercise classes. METHODS: A 12-month prospective cohort study of 207 participants attending community-based SAYGO classes in Dunedin, New Zealand. Types and costs of medical treatment for injuries and circumstances of falls were obtained via standardized fall event questionnaires and phone-administered questionnaires. RESULTS: Eighty-four percent completed the study (160 females, 14 males, mean age = 77.5 [standard deviation = 6.5] years). More than a third of the total falls (55/148 total falls, 37%) did not result in any injuries. Most injuries (45%, n = 67) were sprains, grazes, and bruises. Medical attention was sought 26 times (18%), out of which 6 participants (4%) reported fractures (none femoral). The majority of falls occurred while walking. More falls and injuries occurred outdoors (n = 55). The number of times medical treatment was sought correlated with the number of falls in the previous year (r = 0.50, P = .02). The total number of years attending SAYGO was a significant predictor of lower total number of injuries (stepwise regression ß = -0.157, t = -1.99, P = .048). The total cost of medical treatment across all reported injurious falls was estimated at NZ$6946 (US$5415). DISCUSSION: Older adults participating in SAYGO appear to sustain less severe injuries following a fall than previously reported. More falls and injuries occurred outdoors, suggesting better overall health of these participants. The role of long-term participation in fall prevention exercise classes on injurious falls warrants further investigation.

Long-term participation in peer-led fall prevention classes predicts lower fall incidence.

OBJECTIVE: To investigate the association between length of participation in Steady As You Go (SAYGO) peer-led fall prevention exercise classes for older adults and 12-month fall incidence. DESIGN: Twelve-month prospective cohort study. SETTING: Community settings. PARTICIPANTS: Older adults (N=207; 189 women, 18 men) aged ≥ 65 y (mean age ± SD, 77.7 ± 6.6 y) actively participating in SAYGO classes. INTERVENTION: Peer-led fall prevention exercise classes. MAIN OUTCOME MEASURES: Twelve-month prospective fall incidence data were collected by monthly calendars. Falls in the previous year and number of years of SAYGO participation were obtained by baseline questionnaire. Class attendance was monitored weekly by class attendance records. RESULTS: Mean length ± SD of SAYGO participation was 4.3 ± 2.5 years (range, 1-10 y). Average class attendance was 69%. Crude fall rate was .75 per person-year. Fall incidences at 12 and 24 months were highly correlated (r=.897, P<.001). Longer SAYGO participation (≥ 3 y) resulted in a lower 12-month fall incidence (incidence rate ratio, .90; 95% confidence interval, .82-.99; P=.03) compared with a shorter duration of participation (1-2 y). CONCLUSIONS: SAYGO appears to be an effective fall prevention intervention with a high attendance rate and a lower fall incidence with long-term participation. Prospective controlled studies on long-term participation in peer-led fall prevention exercise programs are needed to confirm and extend these findings.