The cutoff values of functional independence measure scores for predicting discharge destination in the early stroke phase.

This study aimed to determine cutoff values of functional independence measure (FIM) scores to predict the discharge destinations of patients with acute stroke. The sample included 318 patients with acute stroke (mean age, 72.0 years; women, 39%). The discharge destination was categorized into three groups: home, postacute rehabilitation (hospital with convalescent rehabilitation wards), and postacute care (institution without convalescent rehabilitation wards). We assessed FIM after lifting bed restriction. Multinomial logistic regression analyses were used to estimate odds ratios (OR) and 95% confidence intervals (CI) of the FIM scores for predicting discharge destinations, with postacute rehabilitation as a reference. Cutoff values of motor and cognitive FIM scores for distinguishing home from postacute rehabilitation and postacute care from postacute rehabilitation were determined using receiver operating characteristic curves. The proportion of home, postacute rehabilitation, and postacute care were 34.6%, 41.8%, and 23.6%, respectively. After adjustments for clinical variables, the ORs (95% CIs) for motor and cognitive FIM scores for home versus postacute rehabilitation were 1.08 (1.04-1.11) and 1.05 (0.98-1.12). Furthermore, those for postacute care versus postacute rehabilitation were 1.01 (0.98-1.04) and 0.92 (0.87-0.98). The cutoff values of the motor and cognitive FIM scores for distinguishing home from postacute rehabilitation were 37.5 (sensitivity: 0.92; specificity: 0.64) and 23.5 (sensitivity: 0.78; specificity: 0.67). Furthermore, those for distinguishing postacute care from postacute rehabilitation were 15.5 (sensitivity, 0.81; specificity, 0.51) and 12.5 (sensitivity, 0.74; specificity, 0.64). The identified cutoff values may serve as early indicators for predicting discharge destinations from acute stroke care.

The extracellular-to-total body water ratio reflects improvement in the activities of daily living in patients who experienced acute stroke.

OBJECTIVES: To determine the relationship between bioelectrical impedance analysis (BIA) parameters, including the extracellular water-to-total body water ratio (ECW/TBW), and the activities of daily living (ADL) improvement, in patients who experienced acute stroke. MATERIALS AND METHODS: This retrospective cohort study included 307 patients (mean age, 72 years; 39 % female) who experienced acute stroke and were admitted to the stroke unit of the Nippon Medical School Hospital (Bunkyo-ku, Tokyo, Japan) between April 2021 and March 2022. The Functional Independence Measure (FIM) was assessed at initial rehabilitation and discharge, and FIM effectiveness was calculated as ADL improvement in the participating acute care hospitals. BIA markers included the skeletal muscle mass index (SMI), phase angle (PhA), and ECW/TBW. Multiple linear regression models were used to estimate the relationship between the FIM effectiveness and each BIA marker. RESULTS: The mean (±SD) FIM effectiveness was 0.45 ± 0.36. The proportions of low SMI (male, <7.0 kg/m2; female, <5.7 kg/m2) and low PhA (male <5.36 degrees, female <3.85 degrees), were 48.9 % and 43.3 %, respectively. In addition, the proportions of of low (<0.36), normal (0.36-0.40), and high (>0.4) ECW/TBW ratios were 1.3 %, 78.5 %, and 20.2 %, respectively. After adjustments for demographic and clinical variables, low PhA, low ECW/TBW, and high ECW/TBW were all significantly associated with FIM effectiveness (P < 0.05), with ß coefficients of -0.126, -0.089, and -0.117, respectively. CONCLUSIONS: Low and High ECW/TBW and low PhA levels were negatively correlated with improvements in ADL. The ECW/TBW ratio may be an additional indicator of rehabilitation trainability in patients who experience acute stroke.

Prevalence and outcome of pre-onset frailty in patients with acute stroke.

BACKGROUND: Frailty in older individuals is an underappreciated condition that affects the incidence and/or prognosis of stroke. OBJECTIVES: We evaluated the prevalence of pre-onset frailty in patients with acute first-onset and recurrent strokes and association between pre-onset frailty and functional disability at hospital discharge. METHODS: This prospective cohort study included 210 acute stroke patients admitted to the Stroke Unit of Nippon Medical School Hospital during November 2021-June 2022. The mean participant age was 79.2 ± 7.4 years. Age, sex, pre-onset frailty, body mass index (BMI), stroke type, medical history, and National Institutes of Health Stroke Scale (NIHSS) score at admission were evaluated. Frailty was defined as a clinical frailty scale (CFS) score ≥ 5. Frailty prevalence was calculated for all patients, and scores of functional disabilities at discharge were evaluated using modified Rankin scale. RESULTS: Overall frailty prevalence was 31% in all stroke patients, with 24% and 47% of first-onset and recurrent strokes, respectively. Pre-onset frailty, NIHSS score at admission, age, stroke type, previous stroke, sex, BMI, dyslipidemia, and atrial fibrillation were significantly associated with functional disability at discharge. Logistic regression analysis revealed that CFS score, NIHSS score at admission, and previous stroke were independent predictors of functional disability at discharge. CONCLUSIONS: Approximately one-fourth of patients with first-onset stroke had pre-onset frailty; the rate doubled in recurrent stroke; these rates appear to be much larger than rate in healthy individuals. Pre-onset frailty, a negative independent factor affecting functional disability at discharge, is important for pre-onset frailty evaluation and rehabilitation intervention in acute stroke patients.

Effect of Exercise Therapy on Incident Admission in Patients with Type 2 Diabetes Mellitus Undergoing Inpatient Diabetes Self-management Education and Support Tokyo Metropolitan Toshima Hospital, Tokyo Metropolitan Hospital Organization, Japan.

BACKGROUND: Exercise therapy is the key to preventing admission of patients with type 2 diabetes mellitus (T2DM). However, a few studies have examined the effects of exercise therapy on patients with T2DM undergoing inpatient diabetes self-management education and support (IDSMES). OBJECTIVE: This study investigated whether exercise therapy influenced the incidence of admission after discharge in patients with T2DM undergoing IDSMES. METHODS: This retrospective cohort study included patients with T2DM who underwent IDSMES between June 2011 and May 2015. Overall, 258 patients were included in this study. The exercise therapy program was implemented in June 2013. Accordingly, patients diagnosed between June 2011 and May 2013 were categorized as the non-exercise therapy program group, while those diagnosed between June 2013 and May 2015 were categorized as the exercise therapy program group. Outcomes were incident diabetes-related and all-cause admissions within 1 year of discharge. Multiple logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of the exercise therapy program's impact on the outcomes. RESULTS: Within 1 year of discharge, 27 (10.5%) patients underwent diabetes-related admissions and 62 (24.0%) underwent all-cause admissions. Multiple logistic regression analyses showed a significant association of the exercise therapy program with incident diabetes-related and allcause admissions [OR: 0.22 (95% CI: 0.08-0.59) and 0.44 (95% CI: 0.22-0.86), respectively]. CONCLUSION: Exercise therapy programs significantly lowered the incidences of diabetes-related and all-cause admissions. This indicates that implementing exercise therapy during hospitalization may be important for preventing admissions of patients with T2DM receiving IDSMES.

Rapid Recovery in a Patient with Severe COVID-19 after a Low-Load, High-Frequency Rehabilitation Program Using an Ergometer in the Supine Position.

BACKGROUND: Rehabilitation therapy for patients with severe coronavirus disease 2019 (COVID-19) is crucial; however, studies regarding rehabilitation strategies for intensive care unit (ICU) patients with COVID-19 are limited. We report a case of severe COVID-19 in an ICU patient whose physical function and basic movement ability rapidly improved after the initiation of active aerobic exercise in the supine position. CASE: A 70-year-old man with hypertension and obesity was admitted to the ICU and managed with a ventilator because of severe COVID-19. Physical therapy started on postadmission day 34. Problems encountered during physical therapy included low saturation of percutaneous oxygen (SpO2; <90%), dyspnea with a light exercise load, advancing muscle weakness, and endurance decline. The rehabilitation program included getting out of bed and resistance training of the upper and lower limbs twice daily while maintaining SpO2 at ≥90%. After ventilator weaning, we initiated aerobic training using a supine ergometer with varying load volume. On discharge from the ICU on postadmission day 45, the patient's physical function (handgrip strength, Medical Research Council score, and Borg scale) and basic movement ability (Functional Status Score for ICU) rapidly improved. CONCLUSION: Rehabilitation therapy involving aerobic cycling training based on a quantitative load setting may be effective in treating COVID-19.

Effect of Simultaneous Dual-Task Training on Regional Cerebral Blood Flow in Older Adults with Amnestic Mild Cognitive Impairment.

BACKGROUND: No previous study has examined the effect of dual-task training using changes in regional cerebral blood flow (rCBF) using single-photon emission computed tomography (SPECT) as an outcome. OBJECTIVE: This study aimed to examine the effects of simultaneous dual-task training of exercise and cognitive tasks on rCBF using SPECT in older adults with amnestic mild cognitive impairment (aMCI). METHODS: In this non-randomized control trial, 40 older adults with aMCI participated from May 2016 to April 2018. Outpatients in the intervention group (n = 22) underwent 24 sessions (12 months) of dualtask training twice a month for 60 mins per session. Participants in the control group (n = 18) continued to have regular outpatient visits. The primary outcome was rCBF at baseline and after 12 months, which was compared in each group using the two-sample t-test. The secondary outcomes were the rate of reversion and conversion from aMCI after 12 months. RESULTS: Of the 22 participants in the intervention group, six dropped out; therefore, 16 were included in the analysis. The intervention group showed more significant increases in rCBF in multiple regions, including the bilateral frontal lobes, compared with the control group. However, the rates of reversion or conversion from mild cognitive impairment (MCI) were not significantly different. CONCLUSION: Dual-task training for older adults with aMCI increased rCBF in the frontal gyrus but did not promote reversion from MCI to normal cognition. Future intervention studies, such as follow-up examinations after the intervention, are warranted to consider long-term prognosis.

Combined effect of lower muscle quality and quantity on incident falls and fall-related fractures in community-dwelling older adults: A 3-year follow-up study.

OBJECTIVE: Falls and fractures are serious geriatric adverse events worldwide, and skeletal muscle is considered to be a key factor in these incidents. The objective of this study was to investigate the combined effect of lower muscle quality and quantity on the incidence of falls and fall-related fractures in a 3-year follow-up period among community-dwelling older adults. METHODS: We recruited community-dwelling adults aged 65 years and older who were living independently in 2018. A total of 773 older participants were analyzed in this study. The outcomes were incident falls and fall-related fractures during the 3-year follow-up period. At baseline, we assessed muscle quality and quantity using ultrasonography, and we categorized the participants into four groups based on their combination of poor/better muscle quality and poor/better muscle quantity. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95 % confidence intervals (CIs) of the relationships among items in the four groups and the time to incident falls and fall-related fractures. RESULTS: During the 3-year follow-up period, 178 participants (23.0 %) had a fall incident and 51 participants (6.6 %) had fall-related fractures. Older adults with lower muscle quality and quantity had significantly elevated risks of incident falls according to multivariate analyses using older adults with better muscle quality and quantity as the reference (adjusted HR: 1.54 [95 % CI 1.06-2.23]). However, there were no significant differences in fall-related fractures among the four groups. CONCLUSION: We found that lower muscle quality and quantity led to higher incidents of falls; thus, identifying community-dwelling older adults with lower muscle quality and quantity is necessary to provide them fall preventive measures and maybe to reduce fall-related outcomes.

What is the optimal nutritional assessment tool for predicting decline in the activity of daily living among older patients with heart failure?

The clinical importance of nutritional management in activities of daily living (ADL) among older inpatients with heart failure (HF) is greatly increasing. We determined the optimal nutritional assessment tool that can predict ADL decline among older inpatients with HF. We prospectively investigated 91 inpatients aged ≥ 65 years with HF in an acute hospital. We measured their nutritional status at admission using nutrition indices: the controlling nutritional status (CONUT), the geriatric nutritional risk index, the prognostic nutritional index, and the mini nutritional assessment. Logistic regression analysis was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of the relationships between the malnutrition status assessed by each nutritional index category and the ADL decline measured by the Barthel index (BI) in the univariate and multivariate analyses. Among the participants, 28.6% (n = 26; median age 81.5 years; 69.2% men) of the participants were included in the Reduced BI group and 71.4% (n = 65; median age 79.0 years; 67.7% men) in the Maintained BI group. The Reduced BI group showed a significantly higher CONUT value than the Maintained BI group, but there were no significant differences in other nutritional indices. In the multivariate logistic regression analysis, a higher CONUT score was associated with a significantly elevated risk of Reduced BI (adjusted OR 0.24; 95%CI 0.08-0.75; p = 0.014). We found that CONUT is an appropriate nutritional assessment tool for predicting ADL decline among older inpatients with HF in the early phase of hospitalization.

Relationship between longitudinal changes in skeletal muscle characteristics over time and functional recovery during intensive rehabilitation of patients with subacute stroke.

BACKGROUND: Stroke is a disease that easily impairs skeletal muscle characteristics, resulting in low quantity, low quality, and poor strength. However, the recovery process of skeletal muscles in patients with stroke is not well established. OBJECTIVES: We aimed to determine the longitudinal changes in skeletal muscle characteristics in patients with stroke during intensive rehabilitation and examine their relationship with functional recovery. METHODS: Eighty-five patients with stroke were prospectively recruited. We defined muscle quantity and quality as ultrasonographic muscle thickness and echo intensity, respectively, and muscle strength as knee extension strength. These skeletal muscle characteristics were compared at four time points: on admission, after 2 weeks, after 4 weeks, and at discharge. We also explored the relationship between changes in skeletal muscle characteristics and functional recovery. RESULTS: Non-paretic knee extension torque (F = 5.838, P = .001), paretic quadriceps thickness (F = 2.943, P = .039), and paretic tibialis anterior thickness (F = 4.654, P = .004) improved over time, and changes in the paretic side quadriceps thickness were significantly associated with recovery for balance ability (odds ratio, 1.05; 95% confidence interval, 1.00-1.09; P = .048). CONCLUSIONS: The present study revealed that knee extension muscle strength on the non-paretic side and quadriceps and tibialis anterior thickness on the paretic side significantly improved over time and that changes in the paretic side quadriceps thickness were associated with the recovery of balance ability.

Relationship between the Kihon Checklist and all-cause hospitalization among community-dwelling older adults.

AIM: To examine the relationship between the Kihon Checklist (KCL) and incidence of hospitalization among community-dwelling older adults. METHOD: We analyzed the cohort data of 2920 community-dwelling adults aged ≥65 years, who were living independently in a city in Shiga prefecture. We investigated the frailty status, instrumental activities of daily living, physical function, nutritional status, oral function, homebound status, cognitive function and mood using the KCL in the baseline survey. The outcome was incident all-cause hospitalization in the 2-year period. Logistic regression analysis was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of the relationships between the frailty status and each domain of the KCL as well as all-cause hospitalization. RESULTS: The prevalence of frailty, pre-frailty and robustness were 29.7%, 34.5% and 35.8%, respectively. During the 2-year follow-up period, 417 participants (14.3%) underwent an incident of all-cause hospitalization. The participants with frailty (adjusted OR 1.38, 95% CI 1.05-1.81) had a significantly elevated incidence of hospitalization according to the multivariate analysis compared with patients with robustness, but not in participants with pre-frailty (adjusted OR 1.07, 95% CI 0.82-1.40). Participants with low physical function (adjusted OR 1.45, 95% CI 1.12-1.87) and depressed mood (adjusted OR 1.35, 95% CI 1.08-1.70) had a significantly elevated incidence of hospitalization according to multivariate analysis compared with non-risk. CONCLUSION: These results suggest that older adults with frailty are more likely to be hospitalized and that the KCL may be the screening tool to estimate the hospitalization risk. Geriatr Gerontol Int 2022; 22: 132-137.

Relationship Between Long-Term Objectively Measured Physical Activity and Glycemic Control in Type 2 Diabetes Mellitus Patients: A Prospective Cohort Study.

INTRODUCTION: Increasing physical activity (PA) improves glycemic control in patients with type 2 diabetes mellitus (T2DM). However, whether long-term objectively measured PA is related to glycemic control remains unclear. The aim of this study was to investigate the relationship between long-term objectively measured PA and glycemic control in T2DM patients. RESEARCH DESIGN AND METHODS: This prospective cohort study recruited T2DM patients admitted to a hospital-based diabetes management and education program. The primary outcome was glycemic control by hemoglobin A1c at 6 months after discharge. We defined poor glycemic control according to the Japanese Clinical Practice Guidelines. The PA was objectively measured using a three-axis accelerometer during 6 months' period after discharge. The representative value of PA was the average daily steps during the measurement period and was divided into quartiles. To determine the relationship between the daily steps and poor glycemic control, we performed a multivariate logistic regression analysis. RESULTS: Ninety-four participants were enrolled in the study. Their median age was 59 years, and 38 (40.0%) of them showed poor glycemic control. Multivariate logistic regression analysis showed that the first (Q1, ≤ 6106 steps/day) and second quartiles (Q2, 6107-8258 steps/day) had significantly elevated risks of poor glycemic control compared to Q4 (≥ 10,542 steps/day), with odds ratios of 8.55 [95% confidence intervals (CI) =1.43-51.23] and 15.62 (95% CI 2.63-92.87), respectively. CONCLUSION: We found that lesser PA was significantly associated with poor glycemic control in T2DM patients. This finding may be beneficial for clinicians while providing long-term advice to diabetic patients.

Impact of physical, cognitive, and psychological functions on incident homebound status after discharge among hospitalized older patients: A clinical-based prospective study.

PURPOSE: Physical and cognitive/psychological functions are risk factors for incident homebound status. However, there are only a few studies exploring the factors related to homebound status in hospitalized older patients. The aim of this study was to determine the relationship between physical, and cognitive/psychological function at discharge among hospitalized older patients and the risk of undergoing homebound status after discharge. METHODS: We analyzed the cohort data of hospitalized older patients (age ≥65 years) with internal medical problems. The main outcome was the incidence of homebound status a month after discharge. Physical functions were measured by handgrip strength (HG), knee extension strength (KES), one-leg stance (OLS), and walking speed (WS). Cognitive and psychological functions were assessed using the Mini-Mental State Examination (MMSE) and Geriatric Depression Scale-5 (GDS-5), respectively. Poisson regression models were used to estimate the risk ratios (RR) and 95 % confidence intervals (CIs) of the relationships between physical, cognitive, and psychological functions as well as the homebound status. RESULTS: A total of 178 participants who completed the follow-up were analyzed mean age (standard deviation) 76.2 (6.9) years. A month after discharge, 23 participants were deemed homebound, for a cumulative incidence (95 %CI) of 12.9 % (8.0 %-17.8 %). The RR (95 %CI) estimated by Poisson regression were 3.51 (1.30-9.48), 0.15 (0.03-0.72) and 0.11 (0.01-0.92) for low KES, maximum WS and comfortable WS, respectively. However, HG, OLS, MMSE, and GDS-5 were not significantly associated with the incidence of homebound status. CONCLUSION: Physical functions can predict the incidence of homebound status after discharge among hospitalized older patients.

The influence of the combination of visiting frequency of family caregivers and pre-admission frailty status on dependency after discharge among hospitalized older patients: a clinically-based prospective study.

PURPOSE: This study aims to determine whether the combination of visiting frequency of the family caregiver and frailty status has an additive effect on the incidence of dependency among hospitalized older patients. METHODS: We analyzed the prospective cohort data of hospitalized older patients (65 years and older) with internal medical problems. The main outcome showed patients' dependency from admission to a month after discharge. We investigated the visiting frequency of family caregivers and the frailty status and categorized respondents into 4 groups: group 1, visiting frequency 3-7 times a week and non-frailty; group 2, visiting frequency 0-2 times a week and non-frailty; group 3, visiting frequency 3-7 times a week and frailty; or group 4, visiting frequency 0-2 times a week and frailty. We used the Cox proportional hazards regression to estimate the hazard ratios (HR) and confidence intervals (95% CI) of relationships between the combination of visiting frequency and frailty status, and dependency. RESULTS: A total of 182 participants who completed the follow-up were analyzed. During the follow-up period, 45 participants (24.7%) showed some dependency. The hazards regression showed that the low visiting frequency group with presence of frailty had the most increased dependency, compared to other groups (adjusted HR 8.61 [95% CI 3.38-21.98]). CONCLUSIONS: The coexistence of low visiting frequency and the presence of frailty influenced dependency more strongly than each factor alone. These findings suggest that the combination of visiting frequency and frailty status is a useful predictor for future dependency.

Relationship between tongue muscle quality and swallowing speed in community-dwelling older women.

OBJECTIVE: The aim of this study was to investigate the relationship between tongue muscle quality index, which was represented as tongue muscle pressure divided by tongue muscle mass, and swallowing speed in community-dwelling older women. METHODS: The inclusion criteria for this cross-sectional study were that participants be community-dwelling older women aged 65 years and above without dysphagia. The exclusion criteria were stroke and Parkinson's disease that directly cause dysphagia. We measured tongue muscle thickness and maximum tongue pressure and the tongue muscle quality index, which was defined as the maximum tongue pressure divided by tongue muscle thickness. We investigated swallowing speed via a 100 ml water swallowing test. To assess the relationship between tongue muscle characteristics and swallowing speed, we performed stepwise multiple regression analysis. RESULTS: Ninety-three participants were enrolled in this study (mean age: 84.2 ± 4.7 years). A stepwise multiple regression analysis showed that age (ß = - 0.292, p < 0.01) and tongue muscle quality index (ß = 0.267, p < 0.01) were related to swallowing speed. CONCLUSION: We found that tongue muscle quality index was related to swallowing speed in community-dwelling older women. According to our findings, it is possible that the tongue muscle quality index is a useful parameter for assessing swallowing speed in older women without dysphagia.

Factors associated with functional recovery in Japanese patients with convalescent stroke stratified by age: a multicenter observational study.

Factors associated with functional recovery after stroke may differ by age demographics because the aging process leads to various regressive changes. The aim of this study was to identify factors related to functional recovery in Japanese patients with convalescent stroke stratified by age. A multicenter retrospective observational study was conducted in 243 patients from six convalescent inpatient rehabilitation wards. Participants were categorized into three groups: 40-64, 65-74, and ≥75 years. Demographic data, laboratory data, physical function, and cognitive function were collected upon admission, and outcome measures were represented using the relative gain of the Functional Independence Measure (FIM effectiveness) during hospitalization. Stepwise multivariate logistic analysis was performed to identify the significant factors for functional recovery in each group. In the 40-64 years group, stroke type [odds ratio (OR), 10.38; 95% confidence interval (CI), 2.22-48.59], spatial neglect (OR, 7.61; 95% CI, 2.07-28.00), and memory disorder (OR, 4.68; 95% CI, 1.08-20.30) were shown to be significant factors. In the 65-74 years group, only memory disorder (OR, 3.42; 95% CI, 1.19-9.81) was significant. In the ≥75 years group, low albumin level (OR, 3.35; 95% CI, 1.05-10.67), severe motor impairment (OR, 5.11; 95% CI, 1.14-22.97), and memory disorder (OR, 4.34; 95% CI, 1.43-13.23) were significantly related to poor functional recovery. In conclusions, the findings showed that there were different trends among the factors related to poststroke functional recovery among the three age groups.

[Relevance of the five-repetition sit-to-stand test for diagnosing sarcopenia in elderly inpatients with cardiac disease].

PURPOSE: The aim of this study was to determine the reference values for diagnosing sarcopenia using the five-repetition sit-to-stand test in elderly inpatients with cardiac disease. METHODS: We studied 71 inpatients with cardiac disease ≥65 years of age (mean age 78.0±7.9 years, 42.3% women) who were admitted between April 2015 and March 2016. Patients were assessed for sarcopenia, and we performed the five-repetition sit-to-stand test. We defined sarcopenia using the Asian Working Group for Sarcopenia-suggested diagnostic algorithm. A logistic regression analysis was performed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of the relationship between sarcopenia and the five-repetition sit-to-stand test. A multivariate analysis showed that the age, admission diagnosis, the New York Heart Association classification, the Charlson comorbidity index, and the ratio of extracellular to total body water were relevant covariates. The cut-off value of the five-repetition sit-to-stand test to diagnose sarcopenia was determined using a receiver operating characteristic curve. RESULTS: Sarcopenia was diagnosed in 25 patients (35.2%). A multivariate logistic regression analysis showed that the five-repetition sit-to-stand test was significantly associated with sarcopenia (p=0.024), and the OR (95% CI) was 1.31 (1.04-1.65). The cut-off value of the five-repetition sit-to-stand test to diagnose sarcopenia was 10.9 s (sensitivity 80.0%, specificity 70.0%, area under the curve 0.83). CONCLUSIONS: The five-repetition sit-to-stand test is a useful screening tool for sarcopenia in elderly inpatients with cardiac disease. The cut-off value to diagnose sarcopenia was 10.9 s in this study.

Synergistic effect of bodyweight resistance exercise and protein supplementation on skeletal muscle in sarcopenic or dynapenic older adults.

AIM: The objective of this trial was to investigate the synergistic effects of bodyweight resistance exercise and a protein supplement with vitamin D on skeletal muscle in sarcopenic or dynapenic older adults. METHODS: This was a four-arm randomized controlled trial. Sarcopenic or dynapenic older adults were recruited for this trial. After screening, a total of 112 older adults were randomly allocated among four groups; 28 older adults each were enrolled in the combined resistance exercise and nutritional supplementation group, the exercise alone group, the nutritional supplementation alone group, and the control group. Participants in the combined group and exercise alone groups took part in a bodyweight resistance exercise program for 12 weeks. Protein and vitamin D supplements were provided every day for 12 weeks for the participants in the combined group and nutritional supplementation alone groups. We assessed the echo intensity of participants' thigh muscle using ultrasonography, measured their appendicular muscle mass using a bioelectrical impedance data acquisition system, and tested their knee extension strength and physical function. RESULTS: Participants in the combined group had a significantly greater improvement in rectus femoris echo intensity and knee extension torque than those in the other groups (P < 0.05). Furthermore, the combined program increased appendicular muscle mass in sarcopenic older adults (P < 0.05), but not in older adults with low physical function with normal muscle mass. CONCLUSIONS: The present study confirmed the synergistic effect of bodyweight resistance exercise and protein supplement with vitamin D on muscle quality and muscle strength in sarcopenic or dynapenic older adults. Geriatr Gerontol Int 2019; 19: 429-437.

The Relationship between Walking Speed and Step Length in Older Aged Patients.

Compared with elderly people who have not experienced falls, those who have were reported to have a shortened step length, large fluctuations in their pace, and a slow walking speed. The purpose of this study was to elucidate the step length required to maintain a walking speed of 1.0 m/s in patients aged 75 years or older. We measured the 10 m maximum walking speed in patients aged 75 years or older and divided them into the following two groups: Those who could walk 1.0 m/s or faster (fast group) and those who could not (slow group). Step length was determined from the number of steps taken during the 10 m-maximum walking speed test, and the step length-to-height ratio was calculated. Isometric knee extension muscle force (kgf), modified functional reach (cm), and one-leg standing time (s) were also measured. We included 261 patients (average age: 82.1 years, 50.6% men) in this study. The fast group included 119 participants, and the slow group included 142 participants. In a regression logistic analysis, knee extension muscle force (p = 0.03) and step length-to-height ratio (p < 0.01) were determined as factors significantly related to the fast group. As a result of ROC curve analysis, a step length-to-height ratio of 31.0% could discriminate between the two walking speed groups. The results suggest that the step length-to-height ratio required to maintain a walking speed of 1.0 m/s is 31.0% in patients aged 75 years or older.