Johan Pelssers

Is knee extension strength a better predictor of functional performance than handgrip strength among older adults in three different settings

BACKGROUND The first purpose was to examine whether knee extension strength is a better predictor of functional performance than handgrip strength among older adults (≥60 years). The second purpose was to identify functionally relevant cut-off values for muscle strength. METHODS 770 community-dwelling older adults, 104 older adults living in assisted living facilities and 73 nursing home residents were included. Static strength, expressed in kg/kg body weight (BW), was measured using two field tests: handgrip (GRIP/BW) and knee extension (KNEE/BW) test. Functional performance was assessed with 6-Minute Walk Distance (6MWD, N=947) and modified Physical Performance Test (mPPT, N=152). RESULTS Both GRIP/BW and KNEE/BW were positively correlated with functional performance in all settings (p<0.05). In the community and nursing homes, both strength variables equally contributed to functional performance. In assisted living facilities, KNEE/BW (R(2)6MWD=0.39 and R2mPPT=0.35) was clearly a better predictor of functional performance than GRIP/BW (R(2)6MWD=0.15 and R2mPPT=0.12). GRIP/BW had no added value to KNEE/BW in order to explain the variance in functional performance. Functionally relevant cut-off values for static strength, for men and women respectively, were set at 0.40 and 0.31 for KNEE/BW and at 0.43 and 0.31 for GRIP/BW. CONCLUSIONS Handgrip and knee extension strength are both important predictors of functional performance in older adults. In assisted living facilities only, knee extension strength was clearly more predictive than handgrip strength. Both cut-off values appear to be highly sensitive to screen for functionally relevant muscle weakness in older adults.

Ergometer-cycling with strict versus minimal contact supervision among the oldest adults: A cluster-randomised controlled trial

OBJECTIVE To evaluate the feasibility and short- and long-term effects of two 10-wk structured ergometer-cycling programs among elderly in assisted-living residences. DESIGN, SETTING, AND PARTICIPANTS Eight assisted-living residences (N=95; age=81.2±5.9years) were randomly assigned to one of three conditions: 1) ergometer-cycling with strict coach-supervision (STRICT, N=3; n=35); 2) ergometer-cycling with autonomy-supportive minimal contact coach-supervision (AUT; N=3; n=36); or 3) control condition (CON; N=2, n=24). INTERVENTION Three-weekly progressive ergometer-cycling sessions for 10 weeks. MAIN OUTCOME MEASURES Feasibility, physical activity (PA), muscular strength, functional performance and quality of life (baseline, post-intervention (10weeks) and 6-month follow-up). RESULTS 83 participants were analyzed post-intervention, 75 at follow-up. Adherence was higher in STRICT than AUT during the intervention (p=0.001), but not during follow-up. Compared with CON, both programs showed positive short- and long-term effects on moderate-intensity PA (p=0.034). With regard to strength, functional performance and well-being, no time-by-group interaction effects were found. When comparing high-adherers (adherence≥80%) to low-adherers, a greater increase in functional performance and in well-being and a trend towards a lower decrease in strength were found in the short-term (p=0.047, p<0.001 and p=0.054, respectively). CONCLUSION Both interventions were feasible and equally effective to increase long-term engagement in PA, irrespective of the type of supervision. When adherence is high, positive effects on strength, performance and well-being can be expected.