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Background: The purposes of this study were: i) to evaluate the association of sit-to-stand (STS) power and body composition parameters [body mass index (BMI) and legs skeletal muscle index (SMI)] with age; ii) to provide cut-off points for low relative STS power (STSrel), ii) to provide normative data for well-functioning older adults and iv) to assess the impact of low STSrel on negative outcomes.Methods: Cross-sectional design (1369 older adults). STS power parameters assessed by validated equations, BMI and Legs SMI assessed by dual-energy X-ray absorptiometry were recorded. Sex- and age-adjusted segmented and logistic regression analyses and receiver operator characteristic curves were used.Results: Among men, STSrel showed a negative association with age up to the age of 85 years (‒1.2 to ‒1.4%year-1; pyear-1; prel were 2.5 W∙kg-1 in men and 1.9 W∙kg-1 in women. Low STSrel was associated with frailty (OR[95%CI]= 5.6 [3.1, 10.1]) and low habitual gait speed (HGS) (OR[95%CI]= 2.7 [1.8, 3.9]) in men while low STSrel was associated with frailty (OR[95%CI]= 6.9 [4.5, 10.5]) low HGS (OR[95%CI]= 2.9 [2.0, 4.1]), disability in activities of daily living (OR[95%CI]= 2.1 [1.4, 3.2]), and low quality of life (OR[95%CI]= 1.7 [1.2, 2.4]) in women. Conclusions: STSrel declined with increasing age in both men and women. Due to the adverse outcomes related to STSrel, the reported cut-off points can be used as a clinical tool to identify this condition among older adults.

Background The purpose of this study was to evaluate the relationship of lower-limb muscle power with mortality and hospitalization. Methods A total of 1 928 participants from the Toledo Study for Healthy Aging were included. Muscle power was assessed with the 5-repetition sit-to-stand test and participants were classified into different groups of relative power (ie, normalized to body mass) according to sex-specific tertiles and their inability to perform the test. Mean follow-up periods for hospitalization and all-cause mortality were 3.3 and 6.3 years, respectively. Results Compared to the high relative muscle power group, men with low (HR [95% CI] = 2.1 [1.2–3.6]) and women with very low and low (HR [95% CI] = 4.7 [3.0–7.4] and 1.8 [1.2–2.7]) relative power had an increased age-adjusted risk of hospitalization. After adjusting for several covariates (age, physical activity, body mass index education, depression, comorbidities, disability, and handgrip strength), these effects were attenuated (men and women with very low relative power: HR [95% CI] = 1.6 [0.9–2.9] and 2.8 [1.6–4.9]). The very low relative muscle power group had also an increased all-cause mortality risk (age-adjusted) in both men and women (HR [95% CI] = 2.3 [1.4–3.9] and 2.9 [1.6–5.3]). After adjusting for all the covariates, a significantly increased mortality risk was observed only in men (HR [95% CI] = 2.1 [1.1–3.8]; women HR [95% CI] = 1.6 [0.8–3.2]), with very low levels of relative power. Conclusions Relative muscle power was independently and negatively associated with mortality and hospitalization in older adults. An augmented all-cause mortality risk was noted in the lowest group of relative muscle power.

This study compared the reliability and validity of different protocols evaluating the force-velocity (F-V) relationship and muscle power in older adults. Thirty-one older men and women (75.8±4.7 years) underwent two F-V tests by collecting the mean and peak force and velocity data exerted against increasing loads until one repetition maximum (1RM) was achieved in the leg press exercise. Two attempts per load were performed, with a third attempt when F-V points deviated from the linear F-V regression equation. Then, the subjects performed 2×3 repetitions at 60% 1RM to compare purely concentric and eccentric-concentric repetitions. The Short Physical Performance Battery was conducted to assess the validity of the different protocols. Significant differences were found in maximal power (Pmax) between mean and peak values and between protocols differing in the number of attempts per load (p3), was significantly more reliable (Pmax: CV=2.6%; ICC=0.99) than the other alternatives. Mean values were also observed to be more associated with physical function than peak values (R2=0.34 and 0.15, respectively; p

Introduction Frailty is a strong predictor of adverse health events, but its impact on cognitive function is poorly understood. Aim To assess cognitive performance in frailty and to identify the frailty stage where cognitive impairment begins. Methods Data were taken from 2044 people aged ≥65 years without cognitive impairment selected from the Toledo Study for Healthy Aging, a population-based cohort of older adults. Frailty status was assessed by 3 different scales: Frailty Phenotype (FP), Frailty Trait Scale (FTS), and Frailty Index (FI). Neuropsychological assessments of different cognitive domains included the Mini-Mental State Examination, Short and Long-Term Memory Recalling Test, the Boston Naming Test, Verbal Fluency Test, Digit Span Forward, Go/No-go Test, Luria Orders Test, Clock Drawing Test, and Serial Word Learning Test. The relationships between the score of the scales and frailty status (robust, prefrail, and frail for FP and quartiles for FTS and FI) were analyzed using multivariate linear regression models including age, sex, and educative level as possible confounders. Results Participants classified as the worst degree of frailty (frail in FP and fourth quartile of FTS and FI) presented more cognitive domains affected and to a higher extent than moderate frail (prefrail and second quartile and third quartile of FTS and FI) and robust (and first quartile of FTS and FI) participants. Conclusions Cognitive performance progressively declined across the frailty state, regardless of the instrument used to assess frailty. In prefrail participants, cognitive impairment may be an early marker of frailty-dependent cerebral involvement and could be already subject to interventions aimed at reducing the transition to frailty.

The assessment and treatment of low relative muscle power in older people has received little attention in the clinical setting when compared to sarcopenia. Our main goal was to assess the associations of low relative power and sarcopenia with other negative outcomes in older people. Methods: The participants were 1189 subjects (54% women; 65–101 years old) from the Toledo Study for Healthy Aging. Probable sarcopenia was defined as having low handgrip strength, while confirmed sarcopenia also included low appendicular skeletal muscle index (assessed by dual energy X-ray absorptiometry) (EWGSOP2’s definition). Low relative (i.e. normalized to body mass) muscle power was assessed with the 5-repetition sit-tostand power test (which uses an equation that converts sit-to-stand performance into mechanical power) and diagnosed in those subjects in the lowest sex-specific tertile. Low usual gait speed (UGS), frailty (according to Fried’s criteria and the Frailty Trait Scale), limitations in basic (BADL) and instrumental activities of daily living (IADL) and poor quality of life were also recorded. Results: Age-adjusted logistic regression analyses demonstrated that low relative muscle power was associated with low UGS (odds ratio (OR) = 1.9 and 2.5), frailty (OR = 3.9 and 4.7) and poor quality of life (OR = 1.8 and 1.9) in older men and women, respectively, and with limitations in BADL (OR = 1.6) and IADL (OR = 3.8) in older women (all p < 0.05). Confirmed sarcopenia was only associated with low UGS (OR = 2.5) and frailty (OR = 5.0) in older men, and with limitations in IADL in older women (OR = 4.3) (all p < 0.05). Conclusions: Low relative muscle power had a greater clinical relevance than low handgrip strength and confirmed sarcopenia among older people. An operational definition and algorithm for low relative muscle power case finding in daily clinical practice was presented.

The aim was to establish whether a short supervised facility-based exercise program improved frailty, physical function and performance in comparison with usual care treatment.This was a quasi-experimental, non-randomized controlled intervention study in frail (2.75 ± 1.25 Frailty Phenotype criteria) older adults (range:77.2-95.8 years). The exercise (EX) group (n = 11) performed concurrent training (power training + high-intensity interval training, HIIT) twice weekly for 6 weeks while the control (CT) group (n = 9) followed usual care.The exercise intervention improved frailty status in 64% of the subjects improving Frailty Phenotype by 1.6 points (95%CI 0.8-2.5, p 0.05), and increasing SPPB score by 3.2 points (95%CI: 2.4-4.0, Cohen's d = 2.0, p 0.05), muscle power by 47% (95%CI: 7-87%, Cohen's d = 0.5, p 0.05), muscle strength by 34%(95%CI: 7-60, Cohen's d = 0.6, p 0.05) and the aerobic capacity by 19% (6 minute walking test +45 m, 95%CI: 7-83, Cohen's d = 0.7, p = 0.054). The CT did not experience any significant changes in frailty status, physical function or performance.A short concurrent exercise program of muscle power and walking-based HIIT training is a feasible and safe method to increase physical performance and improve function and frailty in elder (pre)frail patients.

Introduction Skeletal muscle power has been demonstrated to be a stronger predictor of functional limitations than any other physical capability. However, no validated alternatives exist to the usually expensive instruments and/or time-consuming methods to evaluate muscle power in older populations. Our aim was to validate an easily applicable procedure to assess muscle power in large cohort studies and the clinical setting and to assess its association with other age-related outcomes. Methods Forty community dwelling older adults (70–87 years) and 1804 older subjects (67–101 years) participating in the Toledo Study for Healthy Aging were included in this investigation. Sit-to-stand (STS) velocity and muscle power were calculated using the subject's body mass and height, chair height and the time needed to complete five STS repetitions, and compared with those obtained in the leg press exercise using a linear position transducer. In addition, STS performance, physical (gait speed) and cognitive function, sarcopenia (skeletal muscle index (SMI)) and health-related quality of life (HRQoL) were recorded to assess the association with the STS muscle power values. Results No significant differences were found between STS velocity and power values and those obtained from the leg press force-velocity measurements (mean difference ± 95% CI = 0.02 ± 0.05 m·s−1 and 6.9 ± 29.8 W, respectively) (both p > 0.05). STS muscle power was strongly associated with maximal muscle power registered in the leg press exercise (r = 0.72; p Conclusion The STS muscle power test proved to be a valid, and in general, a more clinically relevant tool to assess functional trajectory in older people compared to traditional STS time values. The low time, space and material requirements of the STS muscle power test, make this test an excellent choice for its application in large cohort studies and the clinical setting.

Introduction: The effects of replacing sedentary time with light or moderate- to vigorous-intensity physical activity on frailty are not well known. Aim: To examine the mutually independent associations of sedentary time (ST), light-intensity physical activity (LPA), and moderate- to vigorous-intensity physical activity (MVPA) with frailty status in older adults. Methods: A total of 628 people aged 65 years from the Toledo Study of Healthy Aging (TSHA) participated in this cross-sectional study. Frailty was measured using the Frailty Trait Scale. Hip-worn accelerometers were used to capture objective measurements of ST, LPA, and MVPA. Linear regression and isotemporal substitution analyses were used to examine associations of ST, LPA, and MVPA with frailty status. Analyses were also stratified by comorbidity. Results: In single and partition models, LPA and MVPA were negatively associated with frailty. Time in sedentary behavior was not associated with frailty in these models. In the isotemporal substitution models, replacing 30 minutes/d of ST with MVPA was associated with a decrease in frailty [b 2.460; 95% confidence interval (CI): 3.782, 1.139]. In contrast, replacing ST with LPA was not associated with favorable effects on this outcome. However, when the models were stratified by comorbidity, replacing ST with MVPA had the greatest effect on frailty in both the comorbidity (b 2.556; 95% CI: 4.451, 0.661) and the no comorbidity group (b 2.535; 95% CI: 4.343, 0.726). Moreover, the favorable effects of LPA in people with comorbidities was found when replacing 30 minutes/d of ST with LPA (b 0.568; 95% CI: 1.050, 0.086). Conclusions: Substituting ST with MVPA is associated with theoretical positive effects on frailty. People with comorbidity may also benefit from replacing ST with LPA, which may have important clinical implications in order to decrease the levels of physical frailty.

Introduction The actual mechanisms leading to a reduced muscle power and functional ability in older adults are poorly understood. We investigated the association between different force-velocity (F-V) profiles and impaired muscle power, physical and cognitive function, frailty, and health-related quality of life (HRQoL) in older people. Methods Physical function (habitual gait speed, timed up-and-go test, sit-to-stand and stair-climbing ability), cognitive function, HRQoL and frailty were evaluated in 31 older subjects (70–85 years). The F-V relationship and maximal muscle power (Pmax) were assessed in the leg press exercise. The skeletal muscle index (SMI) and fat index, moderate-to-vigorous physical activity (MVPA) and sedentary time were obtained from DXA scans and accelerometry, respectively. Results While some subjects showed a force deficit (FDEF), others presented a velocity deficit (VDEF), both leading to an impaired muscle power [Effect size (ES) = 1.30–1.44], and to a likely-very likely moderate harmful effect in their physical and cognitive function, HRQoL and frailty levels (except the VDEF group for cognitive function) [ES = 0.76–1.05]. Leg muscle mass and specific force were similarly associated with force at Pmax, while MVPA but not sedentary time was related to fat index, force at Pmax, and power values (all p Conclusion Older subjects exhibited different mechanisms (force vs. velocity deficits) leading to impaired muscle power. Both deficits were associated with a lower physical function and quality of life, and a higher frailty, whereas only a force deficit was associated with a lower cognitive function. Interventions aimed at reversing age- and/or disuse-related impairments of muscle power might evaluate the specific responsible mechanism and act accordingly.

The executive function is a complex set of skills affected during the aging process and translate into subclinical cerebrovascular disease. Postural instability or motor slowness are some clinical manifestations, being consubstantial with the frailty phenotype, genuine expression of aging. Executive dysfunction is also considered a predictor of adverse health events in the elderly. To study whether the executive dysfunction can be used as an early marker for frailty and the viability of use as a predictor of mortality, hospitalization and/or disability in a Mediterranean population. A population-based cohort study using data from the Toledo Study for Healthy Aging (TSHA). 1690 Spanish elders aged ≥65 years underwent a neuropsychological evaluation in order to measure executive function. To assess whether the accumulation of dysfunctions (in severity and amplitude) could increase the predictive value of adverse health events in relation to each dimension separately an executive dysfunction cumulative index was constructed. Cox proportional hazards model was used to examine mortality and hospitalization over 5.02 and 3.1 years of follow-up, respectively. Executive dysfunction is a powerful predictor of mortality, frailty and disability. Cumulative differences in executive function are associated with high risk of frailty and disability, thus, for each one point increment in the executive function index, the risk of death increased by 7 %, frailty by 13% and disability by 11% (P

a b s t r a c t Objectives: The aims of this study were to identify if the associations of physical activity (PA) and muscle strength may vary throughout the ageing process; to study the differences among genders in the rela- tionships between PA and strength in elderly people and to test whether these differences are explained by the hormonal, nutritional and inflammatory status. Study design: A total of 1741 people ≥65 years of age participated in this cross-sectional study. Main outcome measures: Upper- and lower-limbs maximal voluntary isometric strength was obtained using standardized techniques and equipment. PA was recorded by a validated questionnaire. The associations of PA with strength were assessed using generalized linear regression models with a Gamma- distributed dependent variable. Results: A significant gender by PA interaction was found for all strength-related variables (all P < 0.01). Moreover, when sexual hormones, albumin or C-Reactive protein were taken into account in the model, the results did not significantly change. In women, PA was positively associated with upper and lower- body strength; however in men, PA was only associated with grip and knee strength (both P < 0.01). Higher strength values were associated with higher levels of PA, especially in women. However, this tendency had a different pattern across the age range, showing a stronger association in the 'young' elderly compared with the 'old' elderly. Conclusion: Higher levels of PA are related to greater muscle strength, especially in women and those who were younger. © 2014 Elsevier Ireland Ltd. All rights reserved.

Aging is a process that involves a reduction in muscle strength and anabolic hormone concentrations, which impacts significantly on health.To study the hormone/total strength (H/TS) ratio as a proxy of anabolic insensitivity status in elders, and its relationship with disability, hospitalization, and mortality risk.A total of 1462 persons aged ≥65 years from the Toledo Study of Healthy Aging participated in this study. Serum concentrations of insulin like growth factor 1, total and free testosterone, dehydroepiandrosterone, dehydroepiandrosterone sulfate, and 17β-estradiol were measured. Total maximal voluntary isometric strength was obtained (handgrip, shoulder, hip, and knee) using standardized techniques and equipment. Physical activity was recorded by physical activity scale for the elderly questionnaire. Associations of the H/TS ratio with hospitalization and mortality were assessed using logistic regression models, and participants stratified into quartiles for each H/TS ratio.In women, all individual ratio H/TS models showed a strong to moderate increased risk for death and hospitalization. In men, all models revealed a significant positive association of the ratio H/TS with mortality rate but not for hospitalization (P .01). Participants who have 2 or more H/TS ratios in the worst quartile increased the risk of hospitalization and mortality at least by 2-fold.We demonstrate the main role that muscle function plays in the relationship between the hormonal status and hospitalization and mortality risk; this could be taken into consideration as a way to classify patients for hormonal therapy.

To examine the association between 8-foot time walk and change in cognitive function over time in older Mexican Americans.Data used are from the Hispanic Established Population for the Epidemiological Study of the Elderly (1993-2001).Five southwestern states: Texas, New Mexico, Colorado, Arizona, and California.Two thousand seventy noninstitutionalized Mexican-American men and women aged 65 and older who had a Mini-Mental State Examination (MMSE) score of 21 or greater at baseline.Sociodemographic factors (age, sex, education, marital status), MMSE score, 8-foot walk time, body mass index, medical conditions (stroke, heart attack, diabetes mellitus, depression, and hypertension), and near and distant visual impairment.Using general linear mixed models, it was found that subjects with the slowest 8-foot walk time had a significantly greater rate of cognitive decline over 7 years than subjects with the fastest 8-foot walk time. There was a significant 8-foot walk time-by-time interaction with MMSE scores. Subjects in the lowest 8-foot walk time quartile had a greater cognitive decline over 7 years (estimate=-0.32, SE=0.08; P.001) than those in the highest quartile. This association remained statistically significant after controlling for potential confounding factors.Slow 8-foot walk time in older Mexican-American adults without cognitive impairment at baseline was an independent predictor of MMSE score decline over a 7-year period. Slow 8-foot walk time may be an early marker for older adults in a predementia state who may benefit from early-intervention programs to prevent or slow cognitive decline.

To review published, randomized trials examining the effect of androgen treatment on muscle strength in older men.Systematic review using meta-analysis procedures.Computerized and manual searches.MEDLINE, EMBASE, CINAHL, and the Cochrane Register were searched for trials. Key words included testosterone, androgen, sarcopenia, muscle loss, aged, aging, elderly, older, geriatric, randomized controlled trials, and controlled clinical trials. Sixty-five nonoverlapping studies were found. Meta-analysis methods were used to evaluate the 11 randomized, double-blind trials.Testosterone or dihydrotestosterone (DHT) replacement therapy in healthy men aged 65 and older.Tests of muscle strength.The studies included 38 statistical comparisons. The mean g-index (g(i)) adjusted for sample size was 0.53 (95% confidence interval (CI) = 0.21-0.86). Subanalyses revealed larger effects for measures of lower extremity muscle strength (g(i) = 0.63, 95% CI = 0.03-1.28) than for upper extremity muscle strength (g(i) = 0.47, 95% CI = 0.12-0.84). A larger mean g-index was found for injected (g(i) = 0.95, 95% CI = 0.33-1.58) than topical (g(i) = 0.26, 95% CI = 0.08-0.42) or oral (g(i) = -0.21, 95% CI = -1.40-1.02) administration of testosterone/DHT. Effect sizes were related to study characteristics such as subject attrition and design-quality ratings. Sensitivity analyses revealed that the elimination of one study reduced the mean g-index from 0.53 to 0.23.The results suggest that testosterone/DHT therapy produced a moderate increase in muscle strength in men participating in 11 randomized trials. One study influenced the mean effect size.

To examine the interactive effect of cognition and body weight on hip fracture.A 7-year (1993-2000) prospective cohort study.Five southwestern states (Texas, New Mexico, Arizona, Colorado, and California).Noninstitutionalized Mexican Americans (N=2,653) aged 65 and older and free of hip fracture at baseline interview.Incidence of hip fracture at 2-, 5-, and 7-year follow-up interviews. Body weight and cognition were measured using body mass index (BMI) and Mini-Mental State Examination score, respectively. Covariates included sociodemographics, self-reported medical conditions, visual acuity, and Short Physical Performance Battery.A significant interaction between BMI and hip fracture was found in persons with cognitive impairment (hazard ratio =0.91, 95% confidence interval=0.85-0.98; P=.02), after adjusting for covariates. In the lowest BMI category, the hip fracture rate in cognitively impaired subjects was more than four times the hip fracture rate for subjects who were not cognitively impaired with the same BMI (34.6% vs 8.7%). Hip fracture rates in the highest BMI category were similar in persons with and without cognitive impairment (9.3% vs 6.1%).Low cognitive function increased the conditional association between BMI and hip fracture in older Mexican Americans. The relationship between BMI and cognition is potentially important in identifying persons at risk for hip fracture and supports the need to include cognitive and anthropometric measures in the assessment of hip fracture risk into osteoporosis screening programs.

Background. Cognitive decline and dementia are associated with disability and premature death in old age. We examined whether low handgrip strength predicts subsequent cognitive decline in older Mexican Americans. Methods. We worked with a 7-year prospective cohort of 2160 noninstitutionalized Mexican Americans aged 65 years or older from the Hispanic Established Population for the Epidemiological Study of the Elderly (H-EPESE) who had a Mini-Mental State Examination (MMSE) score � 21 at baseline. Measures included: (i) sociodemographic factors (age, gender, and education), handgrip strength, and near and distant visual impairment from baseline interview; and (ii) MMSE, body mass index (BMI), and medical conditions (stroke, heart attack, diabetes, depression, and hypertension) from four waves of data collection. Results. Using general linear mixed models, we found a significant trend with scores in the lowest quartile of handgrip strength at baseline to be associated with lower MMSE scores over time (estimate ¼� 1.28, standard error ¼ 0.16; p , .0001). There was a significant handgrip Strength-by-Time interaction with MMSE scores. Participants in the lowest handgrip strength quartile had a greater cognitive decline over time (estimate ¼� 0.26, standard error ¼ 0.07; p , .001) than did those participants in the highest quartile. This association remained statistically significant after controlling for potential confounding factors. Conclusion. Older Mexican Americans with reduced handgrip strength at baseline demonstrated a statistically significant decline in cognitive function over a 7-year period. By contrast, participants in the highest handgrip strength quartile maintained a higher level of cognitive function.

Background Age-associated decline in testosterone levels represent one of the potential mechanisms involved in the development of frailty. Although this association has been widely reported in older men, very few data are available in women. We studied the association between testosterone and frailty in women and assessed sex differences in this relationship. Methods We used cross-sectional data from the Toledo Study for Healthy Aging, a population-based cohort study of Spanish elderly. Frailty was defined according to Fried's approach. Multivariate odds-ratios (OR) and 95% confidence intervals (CI) associated with total (TT) and free testosterone (FT) levels were estimated using polytomous logistic regression. Results In women, there was a U-shaped relationship between FT levels and frailty (p for FT2 = 0.03). In addition, very low levels of FT were observed in women with ≥4 frailty criteria (age-adjusted geometric means = 0.13 versus 0.37 in subjects with