Low appendicular skeletal muscle mass (ASM) with limited mobility and poor health outcomes in middle-aged African Americans.

BACKGROUND: Recent efforts to provide a consensus definition propose that sarcopenia be considered a clinical syndrome associated with the loss of both skeletal muscle mass and muscle function that occurs with aging. Validation of sarcopenia definitions that include both low muscle mass and poor muscle function is needed. METHODS: In the population-based African American Health (AAH) study (N = 998 at baseline/wave 1), muscle mass and mobility were evaluated in a clinical testing center in a subsample of N = 319 persons (ages 52-68) at wave 4 (2004). Muscle mass was measured using dual energy x-ray absorptiometry and mobility by a 6-min walk test and 4-m gait walk test. Height corrected appendicular skeletal mass (ASM; 9.0 ± 1.5 in n = 124 males, 8.3 ± 2.2 in n = 195 females) was computed as total lean muscle mass in arms and legs (kilograms) divided by the square of height (meters). Cross-sectional and longitudinal (6-year) associations of low ASM (bottom 25 % AAH sample; <7.96 males and <7.06 females) and low ASM with limited mobility (4-m gait walk ≤1 m/s or 6-min walk <400 m) were examined for basic activities of daily living (ADL) difficulties, instrumental activities of daily living (IADL) difficulties, frailty, falls, and mortality (longitudinal only). RESULTS: Low ASM with limited mobility was associated with IADL difficulties (p = .008) and frailty (p = .040) but not with ADL difficulties or falls in cross-sectional analyses; and with ADL difficulties (p = .022), IADL difficulties (p = .006), frailty (p = .039), and mortality (p = .003) but not with falls in longitudinal analyses adjusted for age and gender. Low ASM alone was marginally associated with mortality (p = .085) but not with other outcomes in cross-sectional or longitudinal analyses. CONCLUSION: Low ASM with limited mobility is associated with poor health outcomes among late middle-aged African Americans.

Higher C-reactive protein and soluble tumor necrosis factor receptor levels are associated with poor physical function and disability: a cross-sectional analysis of a cohort of late middle-aged African Americans.

BACKGROUND: This cohort of "late middle-aged" African Americans has an excess of disability. We aimed to determine associations of circulating cytokine receptors (sTNFR1, sTNFR2, and sIL-6R) and C-reactive protein (CRP) with disability, physical function, and body composition. METHODS: Stratified sampling of two socioeconomically diverse strata of St Louis, Missouri, occurred in 2000-2001. Inclusion criteria were self-reported black or African American race, born 1936-1950 inclusive, and Mini-Mental State Examination score of 16 or greater. In-home evaluations of handgrip strength, lean body mass percentage (LBM%), physical performance, upper and lower body functional limitations (UBFLs and LBFLs), and basic and instrumental activities of daily living (BADLs and IADLs) were collected. Of the 998 participants, 368 had blood sampled at baseline. Serum was stored and assayed in 2006. RESULTS: Absolute risks were LBFLs of 2 or more, 46%; UBFLs of 1 or more, 23.5%; BADLs of 2 or more, 20.6%; and IADLs of 2 or more, 22.5%. Independent of age, sex, and underlying comorbid conditions, higher CRP and sTNFR were associated with poorer physical performance (beta = -1.462, p < .001 and beta = -0.618, p = .003), UBFLs (odds ratio [OR] 2.26, 95% confidence interval [CI] 1.1-4.64 and OR 1.39, 95% CI 0.96-2.02), LBFLs (OR 2.30, 95% CI 1.19-4.45 and OR 1.91, 95% CI 1.26-2.91), BADLs (OR 2.79, 95% CI 1.03-5.96 and OR 1.66, 95% CI 1.11-2.46), and IADLs (OR 2.13, 95% CI 1.03-4.41 and OR 1.43, 95% CI 0.99-2.08). Higher CRP (beta = -3.251, p <.001), sIL-6R (beta = -6.152, p = .013), and lower adiponectin (beta = 2.947, p = .052) were associated with lower LBM%. CONCLUSIONS: Higher CRP and sTNFR are independently associated with disability and physical dysfunction. Higher sIL-6R, CRP, and lower adiponectin associate with lower LBM%.

Development and validation of a short portable sarcopenia measure in the African American health project.

BACKGROUND: Poor muscle size and function (sarcopenia) have an important role in the age-associated disability process. However, no commonly accepted index of sarcopenia exists for use in epidemiological studies. METHODS: A cohort of 998 community-dwelling African Americans 49-65 years' old at baseline was used to construct the short portable sarcopenia measure (SPSM). SPSM was conceptualized as a measure of sarcopenia that combines estimates of muscle quantity and function into a single scale, is based on component items that can be obtained easily in the field, represents muscle status at a single time point that can be used without sex-specific adjustments, and can be used to follow change in muscle status over time with each person as his or her own control. We used exploratory factor analysis (EFA) to identify a unidimensional scale based on timed chair rises, lean mass, and grip strength divided by height. We used these three items and their EFA factor weights to construct SPSM (mean 9.0, median 9, range 0 [worst] to 18 [best] at baseline). Construct validity of the new measure, over a period of 36 months was examined. RESULTS: SPSM required 8.5 pounds of equipment and 12.4 minutes to complete. It showed good score distribution and convergent, discriminant, and predictive validity with measures of muscle function, body composition, physical performance, psychological factors, and functional limitation cross-sectionally and with muscle function and body composition longitudinally. Extensive sensitivity analyses confirmed SPSM's robustness. CONCLUSIONS: SPSM is a brief, portable, and valid measure of sarcopenia for use in epidemiological research. Similar studies in other populations are needed.

Cognitive behavioral therapy to promote exercise behavior in older adults: implications for physical therapists.

Although exercise has both physical and psychological benefits, most older adults do not exercise on a regular basis. Physical therapists need to explore ways to encourage sustained commitment. This article proposes that cognitive factors contribute to older adults inactivity and that the self regulation of exercise maintenance model is a means of promoting exercise. Cognitive behavioral therapy (CBT), an intervention guided by the self-regulation model, is presented as a practical way to help older adults see how thoughts guide their exercise behavior. The article concludes with a hypothetical case in which principles of CBT are used to promote exercise with older adults.