Different cutoff points to diagnose low muscle mass and prediction of osteoporosis in postmenopausal women.

OBJECTIVE: This study aimed to verify which of the different cutoff points of low muscle mass (LMM) based on appendicular lean mass (ALM) is associated with osteoporosis in postmenopausal women (PMW). METHODS: Cross-sectional study. PMW (n = 355) were classified for the presence of osteoporosis (score <-2.5 standard deviations) at the femoral neck and lumbar spine and LMM (three cutoff points: ALM < 15 kg; ALM/height2 [ALM index] <5.67 kg/m2 and ratio between ALM and body mass index [ALMBMI] <0.512). RESULTS: After adjustments for confounding factors, binary logistic regression showed that ALM and ALM index were associated with osteoporosis at the lumbar spine (odds ratio [OR] = 5.3 [95% CI: 2.3-12.5] and OR = 2.5 [95% CI: 1.0-6.2], respectively) and only ALM was associated with osteoporosis at the femoral neck (OR = 16.1 [95% CI: 4.1-62.5]). When women were classified as having osteoporosis in at least one site, only ALM was associated with osteoporosis (OR = 7.7 [95% CI: 3.3-15.6]). There was no association between ALMBMI and osteoporosis. The predictive value of ALM for osteoporosis decreased after BMI or height were included as a covariate in the model. CONCLUSION: Absolute ALM (<15 kg) seems to be the most suitable for predicting osteoporosis based on LMM in PMW.

Accuracy of the step test to evaluate lower limb muscle strength in community-dwelling older women.

OBJECTIVE: to investigate the accuracy of the step test (ST) to evaluate total lower limb muscle strength (LLMS) in older women. DESIGN: observational cross-sectional study. METHODS: 119 community-dwelling older women were submitted to the ST and LLMS evaluation (isometric peak torque of eight muscle groups of the dominant lower limb). The capacity of the ST to discriminate older women with reduced LLMS was measured using ROC curve, followed by the posttest probability (PoTP) calculation. RESULTS: a ST score of 0.24 cm per cm of participant's height presents a sensitivity of 63.3%, specificity of 77%; enhances the PoTP from 48% to 72% for positive test and decreases the PoTP from 48% to 31% for negative test. CONCLUSION: the ST may complement the clinical screening of reduced LLMS in older women, given that it is a simple and quick low-cost test and allows the evaluation of each lower limb separately.

Relationship Between Lower Limb Muscle Strength and Future Falls Among Community-Dwelling Older Adults With No History of Falls: A Prospective 1-Year Study.

Objective: To investigate whether lower limb muscle strength could be a risk factor for the first fall among nonfaller community-dwelling older adults. Method: Hip, knee, and ankle peak torque (PT) was measured with an isokinetic dynamometer in 101 older adults with no history of falls in the previous year. Next, the authors followed up the participants on a monthly basis by telephone contact to determine the occurrence of fall episodes over a period of 1 year. Multivariate logistic regression adjusted for confounding variables was applied to assess the relationship between falls and lower limb PT. Results: there was no association between lower limb PT and future falls (p > .05). Conclusion: Based on these results, it is important to identify other factors that predispose older adults with no history of falls to falling for the first time, so that early and effective preventive strategies may be elaborated.

Diagnostic Accuracy of Clinical Tests for the Indirect Assessment of Hip Abductor Muscle Strength in Community-Dwelling Older Women.

OBJECTIVE: The objective of this study was to determine the accuracy of 3 clinical tests (lateral step [LS], tandem gait [TG], and single-leg stance [SS]) in identifying older women with reduced hip abductor muscle strength and to determine the post-test probability of each test and of their combination in changing the certainty of diagnosis. METHODS: In this cross-sectional study, a total of 123 older women received clinical testing to obtain the variables LS height, time for TG execution, percentage of errors in TG, and time of permanence on SS and were tested for isometric hip abductor peak torque using an isokinetic dynamometer. Only the dominant lower limb was evaluated. Multiple linear regression analysis with adjustment was performed to determine the association among variables, followed by the receiver operating characteristic curve to identify clinical variables that can discriminate older women with reduced abductor muscle strength. Post-test probability was then calculated based on the receiver operating characteristic curve data. RESULTS: Although the 4 clinical variables showed correlation with abductor peak torque, only LS and TG time were able to discriminate reduced abductor muscle strength with low accuracy (area under the curve was between 0.5 and 0.7). However, the combination of LS and TG time increased post-test probability from 47% (prevalence of weakness in the population) to 76% when both tests were positive and reduced it from 47% to 18% when both tests were negative. CONCLUSION: The combination of the LS test and TG time is useful for the indirect assessment of hip abductor strength in community-dwelling older women. IMPACT: Hip abductor muscle strength is extremely important for function in older women. This study presents clinicians with simple, fast, and inexpensive methods for assessing hip abductor muscle strength.

2D Virtual Reality-Based Exercise Improves Spatial Navigation in Institutionalized Non-robust Older Persons: A Preliminary Data Report of a Single-Blind, Randomized, and Controlled Study.

Background: Spatial navigation is a prodromal dementia marker. Exercise used alongside virtual reality improves many cognitive functions, but effects on spatial navigation are still unclear. Objective: To investigate the effect of virtual reality-based physical exercise with 2D exergames on spatial navigation in institutionalized non-robust older persons. Method: A total of 14 older persons (aged ≧ 60) were randomly allocated to the exergame (EG) and active control (ACG) groups. EG performed exercises with 2D exergames, while the ACG used the same movements as the EG, but without the use of virtual reality. Spatial navigation was assessed through the Floor Maze Test, where the immediate maze time (IMT) and delayed maze time (DMT) were recorded. Results: Spatial navigation was enhanced in EG participants compared to ACG individuals. A significant (p = 0.01) IMT reduction between groups was observed, while DMT time without prior planning was significantly different at the significance threshold (p = 0.07). Conclusions: Virtual reality-based exercise improves the spatial navigation of institutionalized non-robust older persons. This study should be replicated to confirm the findings reported herein. Clinical Trial Registration: This study was registered in the Brazilian Registry of Clinical Trials (Protocol RBR-8dv3kg - https://ensaiosclinicos.gov.br/rg/RBR-8dv3kg).

Association between the trunk muscle function performance and the presence of vertebral fracture in older women with low bone mass.

BACKGROUND: Despite the clinical importance, it has remained unclear which changes in the trunk muscle function parameters are more associated with the presence of vertebral fracture (VF). AIMS: The aim of this study was to verify the association between the trunk muscle function performance and the presence of VF in older women with low bone mass. The secondary aim was to evaluate the correlation between trunk muscle function and both fall history and muscle mass. METHODS: This cross-sectional study was composed by 94 women over 60 years within value of T-Score lumbar spine BMD <- 1.0 DP. Multidimensional evaluations were performed: appendicular skeletal muscle mass index (ASMI) was determined by the total body DEXA; the radiographic evaluations measured the degree of thoracic kyphosis and classification of VF. The trunk muscle function parameters, such as peak torque (PT), rate of torque development (RTD) and torque steadiness (TS) were evaluated by isokinetic dynamometer. The trunk muscle endurance was evaluated by the timed loaded standing test. The adjusted multivariate logistic regression model and multivariate linear regression were performed to verify the association between the variables studied. RESULTS: The results showed that the trunk muscle function parameter with greater association with the presence of VF is TS extensors (OR = 1.70; p < 0.001). The other two significant muscle parameters were: RTD30 flexors (OR = 0.31; p = 0.033) and PT extensors (OR = 0.13; p = 0.009). No statistical association was found between the presence of VF and the ASMI and trunk muscle endurance. No correlation between trunk muscle function and fall history was observed. There was a weak correlation between ASMI and extensor PT (R2 = 0.21; p = 0.027) and extensor RTD30 (R2 = 0.21; p = 0.026). CONCLUSIONS: This study demonstrated that deficit in trunk muscle function has shown a strong association with the presence of VF, highlighting issues heretofore unexplored regarding the association between VF with muscle power and motor control.

Relationship between grip strength and global muscle strength in community-dwelling older people.

There are still conflicting results regarding the association between grip and global muscle strength in older people. Therefore, the objective of the present study was to determine the association between grip strength and global muscle strength, as well as between grip strength and individual trunk, hip, knee and ankle muscle strengths. METHODS: Grip strength was assessed using a manual dynamometer, and trunk, hip, knee and ankle muscle strength with an isokinetic dynamometer, in order to obtain the global muscle strength variable, in 150 older men and women from the community. The association between grip and global muscle strength and between grip strength and the strength of each muscle group was determined through the Pearson correlation test, followed by multivariate linear regression adjusted for sex, age, body mass index, level of physical activity and number of comorbidities. RESULTS: A positive significant association was found between grip strength and global muscle strength in older people (r = 0.690; ß = 10.07; p < 0.001; R2 = 0.604), even after adjustment. There was also a low to moderate association between all the muscle groups and grip strength. However, when the model was adjusted, the relationship between grip strength and ankle dorsiflexor peak torque lost significance (p = 0.924). CONCLUSION: Grip strength can represent global muscle strength in younger older people in the community, even when confounding variables are considered in the statistical model. However, grip strength does not eliminate the need for specific assessment of different muscle groups, when indicated.

Eficácia da tromboprofilaxia não farmacológica em pacientes hospitalizados: estudo caso-controle aninhado / Non-pharmacological thromboprophylaxis efficacy in hospitalized patients: a nested case-control study

Introdução: a trombose venosa adquirida durante hospitalização (TV) é complicação potencialmente fatal, mas prevenível pela tromboprofilaxia primária (TP), que pode ser farmacológica ou não farmacológica (TPNF). A TPNF inclui mobilização precoce do paciente no leito, meias elásticas compressivas graduadas ou compressão pneumática intermitente de membros inferiores. O objetivo deste estudo foi avaliar a eficácia daTPNF em pacientes admitidos em hospital público, ajustando para confundimento por indicação. Material e método: este é um estudo com análise de caso-controle aninhado em coorte do programa de TP do Hospital Naval Marcílio Dias, Rio de Janeiro, entre 1995 e 2001. Os participantes foram pacientes hospitalizados maiores de 18 anos sem anticoagulação ou suspeita de TV à admissão. Casos foram participantes com TV. Cinco controles foram selecionados para cada caso com pareamento por sexo, idade e ano de internação. A medida de desfecho foi a razão de chances (OR) para TV sintomática, diagnosticada objetivamente em participantes submetidos à TPNF comparados a participantes sem TP. Resultados: houve 76 casos entre 21.067 participantes pareados a 379 controles. A OR não ajustada para TV foi de 0,41 (IC 95% 0,22-0,77) e a OR ajustada para confundimento foi de 0,42 (IC 95% 0,19-0,92). A taxa de incidência para TV entre participantes submetidos à TPNF foi de 1,6 por 1.000 internações e entre participantessem TP, 4,0 por 1.000 internações. Conclusão: após ajustes para fatores de confundimento, o risco de TV foi reduzido pela metade com medidas tromboprofiláticas não farmacológicas em relação a pacientes sem tromboprofilaxia.

Introduction: Hospital-acquired venous thrombosis (VT) is a potentially fatal but preventable complication. Thromboprophylaxis may include pharmacological or non-pharmacological strategies (NPTP). NPTP may include early patient ambulation, graduated elastic compressive stockings or compressive pneumatic compression of lower limbs. Our objective was to measure NPTP efficacy in a brazilian public hospital. Material and Method: This is a case-control study nested in a cohort comprising patients admitted to Hospital Naval Marcílio Dias from 1995 to 2001 who participated in the hospital TP program; Participants were over 18 years of age, without anticoagulation or suspected VT at admission. Cases were participants who developed VT during hospital stay. Five controls were matched by age, gender and date of VT to each index case. Outcome was evaluated by OR for VT comparing participants submitted to NPTB to no TP. Results: There were 76 cases matched to 379 controls out of 21,067 participants. Unadjusted OR for VT was 0.41 (95% CI 0.22-0.77) and the adjusted OR for confounding was 0.42 (95% CI 0.19-0.92). VT incidence was 1.6/1000 hospital admissions in participants receiving NFTP and 4.0/1000 hospital admissions in participants with no TP. Conclusion: After adjustment for confounding, venous thrombosis risk was halved by non-pharmacological thromboprophylaxis compared with no thromboprophylaxis.