Physical activity, muscular strength, and polypharmacy among older multimorbid persons: Results from the KORA-Age study.

The purpose of this study was to examine whether physical activity (PA) and muscular strength (MS) are related to polypharmacy. Our cross-sectional analysis was based on 711 patients with multimorbidity (MMB), aged 65-94 years, who participated in the KORA-Age study. Participants underwent a face-to-face interview and extensive physical examinations including anthropometric measurements, registration of chronic diseases, determination of health-related behaviors (smoking, alcohol intake, physical activity, etc.), collection of blood samples and measurement of hand-grip strength. PPha was defined as the use of >4 drugs and MMB as having ≥2 of 13 chronic diseases. Prevalence of PPha was 44.6% (n=317), and a significant difference was found in the number of drugs used between participants with and without PPha (7.2±2.1 vs 2.5±1.2, P<.001). Patients in the lower compared to the upper tertile of physical activity had a significantly increased odds to be on PPha (OR: 1.64, 95% CI: 1.05-2.56, P=.031) after controlling for age, gender, BMI, family status, education, alcohol intake, smoking habits, number of diseases, hs-CRP, and telomere length. On the contrary, no significant association between muscular strength and PPha was found (OR: 1.04, 95% CI: 0.66-1.63, P=.873) after multivariable adjustment. Among older persons with MMB, lower levels of physical activity, but not low muscular strength, are associated with higher odds of PPha. Increasing the levels of physical activity appears to be highly recommended in order to potentially reduce the risk of PPha among multimorbid persons aged 65 and older.

Handgrip strength is inversely and independently associated with multimorbidity among older women: Results from the KORA-Age study.

BACKGROUND: Data on the association between handgrip strength and multimorbidity (MMB) are missing. AIM: The purpose of this study was to examine if handgrip strength is related to MMB in a large population-based sample of older persons. METHODS: The cross-sectional analysis was based on 1079 older people (aged 65-94years), who participated in the KORA-Age study in the Augsburg region, southern Germany. Participants underwent an interview and extensive examinations, including anthropometric measurements, registration of chronic diseases, determination of health-related behaviors (smoking, alcohol intake and physical activity), collection of blood samples, and muscle strength measurement using hand-grip dynamometry. RESULTS: In men, handgrip strength correlated strongly with the number of co-existing diseases (r=-0.176, p<0.001), and the same pattern was observed for women (r=-0.287, p<0.001). Among women, handgrip strength in the lower tertile compared to the upper tertile was significantly associated with an increased odds of having MMB (OR: 2.57, 95% CI: 1.30-5.07, p=0.007) after controlling for age, BMI, education, alcohol intake, smoking habits, medications number, inflammatory markers, telomere length and levels of physical activity. Contrary, no significant association between handgrip strength and MMB was found among men (OR: 1.32, 95% CI: 0.73-2.40, p=0.362) after multivariable adjustment. CONCLUSION: Lower levels of handgrip strength are associated with a higher odd of MMB among older women even after adjusting for traditional and novel confounders. Increasing the levels of muscular strength in older women seems to be important in order to reduce the risk for the co-occurrence of multiple chronic diseases.

Association between muscular strength and inflammatory markers among elderly persons with cardiac disease: results from the KORA-Age study.

Little is known about the association between muscle strength and inflammation in diseased individuals and particularly in cardiac patients. Thus, our purpose was to examine the association of muscular strength with the inflammatory status in older adults with and without cardiac disease. The cross-sectional analysis was based on 1079 adults aged 65-94 years, who participated in the KORA-Age study. Participants underwent an interview and extensive physical examinations including anthropometric measurements, registration of diseases and drug intake, determination of health-related behaviors, collection of blood samples for measurements of interleukin-6 and hs-CRP and muscle strength measurement using hand-grip dynamometry. Cardiac patients (n = 323) had higher levels of IL-6 and poorer muscle strength compared with older adults without cardiac disease. Among persons with cardiac diseases, muscle strength in the lower tertile compared to the upper tertile was significantly associated with increased odds of having elevated IL-6 levels (OR 3.53, 95 % CI 1.18-10.50, p = 0.024) after controlling for age, gender, body fat, alcohol intake, smoking status, diseases, medications and physical activity, whereas the association between muscle strength and hs-CRP remained borderline significant (OR 2.80, 95 % CI 0.85-9.24, p = 0.092). The same trends, with slightly lower odds ratios, were also observed in older adults without cardiac disease. Lower levels of muscular strength are associated with higher concentrations of IL-6 and hs-CRP in elderly individuals with and without cardiac disease suggesting a significant contribution of the muscular system in reducing low-grade inflammation that accompanies cardiac disease and aging.

Training, detraining, and retraining effects on glycemic control and physical fitness in women with type 2 diabetes.

Little is known about the detraining and retraining effects of exercise in patients with diabetes. The purpose of the present study was to investigate the effects of training, detraining, and retraining, using a combined strength and aerobic exercise program on glycemic control in women with type 2 diabetes. Thirteen postmenopausal women with type 2 diabetes (n = 13, age: 55.8 ± 5.1 years) followed a supervised aerobic and strength training program for 9 months, which was interrupted for 3 months (detraining) and resumed again for a period of 9 months (retraining). Anthropometric characteristics, glycemic control, and physical fitness were determined at baseline and after 9, 12, and 21 months. Training induced a small reduction in body mass index (BMI: -3.3%, 95% CI -5.1 to -1.5%), a moderate decrease in fasting plasma glucose (FPG: -12.0%, 95% CI -20.70 to -3.2%), glycosylated hemoglobin (HbA1c: -4.7%, 95% CI -12.1 to 2.7%), and a large decrease in postprandial glucose (PPG: - 12.1%, 95% CI -20.2 to -4.1%). In addition, there was an increase in power output (20.2%, 95% CI 6.9 to 33.6%) and total muscle strength (33.8%, 95% CI 21.4 to 46.1%). Detraining reversed PPG, HbA1c, and physical fitness. Resumption of training, however, led to a moderate decrease in BMI (-5.4%, 95% CI -8.1 to -2.7%), PPG (-9.5%, 95% CI -19.4 to 0.3%), and HbA1c (-6.8%, 95% CI -14.1 to 0.5%), and to large changes in FPG (-20.9%, 95% CI -31.9 to -9.9%), power output (33.1%, 95% CI 17.9 to 48.4%) and total muscle strength (48.2%, 95% CI 34.0 to 62.4%) compared to baseline. Thus, systematic training improves body composition, glycemic control and physical fitness in patients with type 2 diabetes. The cessation of exercise brings about negative alterations, while retraining restores all beneficial adaptations and improves them even more. Therefore, diabetic patients should follow a regular and an uninterrupted exercise program throughout life in order to control glucose metabolism and improve health.

The effects of pre-exercise glycemic index food on running capacity.

This study examined the effects of pre-exercise food on different glycemic indexes (GI) on exercise metabolism and endurance running capacity. 9 subjects performed 3 exercise trials on different days 15 min after ingesting: lentils, (LGI), potatoes, (HGI), and placebo. Each subject ingested an equal amount of each food (1 g/kg body mass) and ran on a level treadmill for 5 min at 60%, 45 min at 70% and then at 80% of VO (2max) until exhaustion. Serum glucose concentrations were higher ( P<0.01) 15 min after the HGI trial compared to the LGI and placebo trials. In addition, serum glucose levels were higher ( P<0.05) during the LGI trial at the time of exhaustion compared to the HGI and placebo trials. Plasma insulin levels, 15 min after ingestion, were higher ( P<0.001) in the HGI trial as compared to the LGI and placebo trials. Exercise time was longer during the LGI trial ( P<0.05) compared to the placebo, but the time to exhaustion in the HGI condition did not differ from the placebo (LGI: 90.0 ± 7.9; HGI: 81.8 ± 5; placebo: 73.0 ± 6.4 min). These results suggest that lentils, the LGI food, ingested 15 min before prolonged exercise maintained euglycemia during exercise and enhanced endurance running capacity.

Pre-exercise glucose ingestion at different time periods and blood glucose concentration during exercise.

The purpose of this study was to investigate the effects of glucose ingestion (GI) at different time periods prior to exercise on blood glucose (BG) levels during prolonged treadmill running. Eight subjects (X+/-SD), age 20+/-0.5yr, bodymass 70.7+/-4.1 kg, height 177+/-4 cm, VO2max 52.8+/-7.8 ml x kg(-1) x min(-1) who underwent different experimental conditions ingested a glucose solution (1 g/kg at 350 ml) 30 min (gl-30), 60 min (gl-60), 90 min (gl-90), and a placebo one 60 min (pl-60) prior to exercise in a counterbalanced design. Afterwards they ran at 65% of VO2max for 1 hour and then at 75 % of VO2max till exhaustion. Fingertip blood samples (10 microl) were drawn every 15 min before and during exercise for the determination of BG levels. Oxygen uptake (VO2), heart rate (HR), and blood lactate (La) were also measured every 15 min during exercise. Peak BG values were reached within 30 min after GI but were different (p < 0.01) at the onset of exercise (gl-30: 147+/-22, gl-60: 118+/-25, gl-90: 109+/-22, pl-60: 79+/-5mg/dl). The two-way ANOVA repeated measures and the Tukey post-hoc test revealed a higher BG concentration (p < 0.05) for the gl-30 and the pl-60 as compared to the gl-60 and gl-90 during running (e.g. 15min run: 82+/-11, 68+/-5, 64+/-3, 78+/-7, and 60min run: 98+/-12, 85+/-12, 83+/-11, 94+/-11 mg/dl for gl-30, gl-60, gl-90, and pl-60, respectively). However, this did not significantly affect the duration of treadmill running. The La levels were higher (p < 0.05) after GI as compared to placebo throughout exercise (values at exhaustion: 4.6+/-0.2, 5.0+/-1.5, 4.8+/- 1.7 mmol/l for gl-30, gl-60, gl-90, and 3.5+/-0.8 mmol/l for placebo). The gl-30 and the placebo fluctuated closer to normoglycaemic levels. The glucose ingestion (60 to 90 min) prior to exercise lowered the blood glucose levels without affecting the duration of running performance at 75% VO2max. Thus, in order to maintain normoglycaemic levels, pre-exercise glucose supplementation should be given 30 min before the onset of exercise.