Justine Slomian

The Effects of Vitamin D on Skeletal Muscle Strength, Muscle Mass, and Muscle Power: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

CONTEXT There is growing evidence that vitamin D plays a role on several tissues including skeletal muscle. OBJECTIVE The aim was to summarize with a meta-analysis, the effects of vitamin D supplementation on muscle function. DATA SOURCES A systematic research of randomized controlled trials, performed between 1966 and January 2014 has been conducted on Medline, Cochrane Database of Systematics Reviews, Cochrane Central Register of Controlled and completed by a manual review of the literature and congressional abstracts. STUDY SELECTION All forms and doses of vitamin D supplementation, with or without calcium supplementation, compared with placebo or control were included. Out of the 225 potentially relevant articles, 30 randomized controlled trials involving 5615 individuals (mean age: 61.1 years) met the inclusion criteria. DATA EXTRACTION Data were extracted by two independent reviewers. DATA SYNTHESIS Results revealed a small but significant positive effect of vitamin D supplementation on global muscle strength with a standardized mean difference (SMD) of 0.17 (P = .02). No significant effect was found on muscle mass (SMD 0.058; P = .52) or muscle power (SMD 0.057; P = .657). Results on muscle strength were significantly more important with people who presented a 25-hydroxyvitamin D level <30 nmol/L. Supplementation seems also more effective on people aged 65 years or older compared to younger subjects (SMD 0.25; 95% CI 0.01 to 0.48 vs SMD 0.03; 95% CI -0.08 to 0.14). CONCLUSIONS Vitamin D supplementation has a small positive impact on muscle strength, but additional studies are needed to define optimal treatment modalities, including dose, mode of administration, and duration.

Estimation of sarcopenia prevalence using various assessment tools

BACKGROUND Sarcopenia is defined as a progressive and generalized loss of muscle mass with either a loss of muscle strength or a loss of physical performance but there is no recommendation regarding the diagnostic tools that have to be used. In this study, we compared the prevalence of sarcopenia assessed using different diagnostic tools. METHODS To measure muscle mass, muscle strength and physical performance, we used for each outcome two different diagnostic tools. For muscle mass, we used Dual Energy X-Ray Absorptiometry (DXA) and bio-electrical impedance analysis (BIA); for muscle strength, we used a hydraulic dynamometer and a pneumatic dynamometer; for physical performance we used the Short Physical Performance Battery test (SPPB test) and the walk speed. Eight diagnostic groups were hereby established. RESULTS A total of 250 consecutive subjects were recruited in an outpatient clinic in Liège, Belgium. Estimated prevalence of sarcopenia varied from 8.4% to 27.6% depending on the method of diagnosis used. Regarding muscle mass, BIA systematically overestimated muscle mass compared to DXA (mean estimated prevalence with BIA=12.8%; mean prevalence with DXA=21%). For muscle strength, the pneumatic dynamometer diagnosed twice more sarcopenic subjects than the hydraulic dynamometer (mean estimated prevalence with PD=22.4%; mean estimated prevalence with HD=11.4%). Finally, no difference in prevalence was observed when the walking speed or the SPPB test was used. A weak overall kappa coefficient was observed (0.53), suggesting that the 8 methods of diagnosis are moderately concordant. CONCLUSION Within the same definition of sarcopenia, prevalence of sarcopenia is highly dependent on the diagnostic tools used.

Quality of life and physical components linked to sarcopenia: The SarcoPhAge study

INTRODUCTION The SarcoPhAge project is an ongoing longitudinal study following community-dwelling elderly subjects with the objective to assess some health and functional consequences of sarcopenia. The sarcopenia diagnosis algorithm developed by the European Working Group on Sarcopenia in Older People (EWGSOP) and used in the present study needs further validation through cross-sectional and longitudinal studies. The aim of the present study is to assess, using this algorithm, the prevalence of sarcopenia and the clinical components linked to this geriatric syndrome. METHODS Participants were community dwelling subjects aged 65years or older. To diagnose sarcopenia, we applied the definition of the EWGSOP. Muscle mass was measured by dual-energy X-ray absorptiometry, muscle strength by a hydraulic dynamometer and physical performance by the SPPB test. Large amounts of socio-demographic, anamnestic and clinical data were collected in all subjects. RESULTS OVER ONE YEAR 534 subjects were recruited for this study (60.5% of women, mean age of 73.5±6.16years), among whom 73 subjects were diagnosed sarcopenic, which represents a global prevalence of 13.7%. Prevalence was 11.8% in men and 14.9% in women. Sarcopenic subjects were older; had a lower Body Mass Index, lower calf, waist, wrist and arm circumferences; presented more cognitive impairments (Mini-Mental State Examination), more comorbidities; were more often malnourished; and consumed more drugs. After adjustment for age, BMI, cognitive status, nutritional status, number of comorbidities and number of drugs, sarcopenic subjects had a worse physical health-related quality of life (SF-36) for the domain of physical functioning, were at higher risk of falls (Timed Up and Go test), were more frail (Fried), presented more often tiredness for the achievement of activities of daily living (Mobility-test), presented less fat mass and obviously less lean mass. Sarcopenic women were also more dependent for housekeeping and handling finances (Lawton scale) than non-sarcopenic ones. CONCLUSION Sarcopenia seems to be associated with many harmful clinical components making this geriatric syndrome a real public health burden. Follow-up data of the SarcoPhAge study will be helpful to assess the outcomes of sarcopenia based on the EWGSOP diagnosis algorithm and its different proposed cut-offs.

The promise of wearable activity sensors to define patient recovery

The recent emergence of mobile health--the use of mobile telecommunication and wireless devices to improve health outcomes, services, and research--has inspired a patient-centric approach to monitor health metrics. Sensors embedded in wearable devices are utilized to acquire greater self-knowledge by tracking basic parameters such as blood pressure, heart rate, and body temperature as well as data related to exercise, diet, and psychological state. To that end, recent studies on utilizing wireless fitness activity trackers to monitor and promote functional recovery in patients suggest that collecting up-to-date performance data could help patients regain functional independence and help hospitals determine the appropriate length of stay for a patient. This manuscript examines existing functional assessment scales, discusses the use of activity tracking sensors in evaluating functional independence, and explores the growing application of wireless technology in measuring and promoting functional recovery.

Reliability of muscle strength measures obtained with a hand-held dynamometer in an elderly population

The objective of this study was to assess the reliability of a hand‐held dynamometer for isometric strength measurements among nursing home residents.

Prevalence of concomitant bone and muscle wasting in elderly women from the SarcoPhAge cohort: preliminary results

BACKGROUND Recent studies suggest that bone and muscle wasting are closely interconnected. OBJECTIVE The aim was of this study is to assess the prevalence of osteoporosis in a population of women diagnosed with sarcopenia. Participants, setting and design: We analyzed cross-sectional data of women, aged 65 years and above, for whom bone mineral density was available at the time of inclusion in the SarcoPhAge (Sarcopenia and Physical impairment with advancing Age) cohort, an ongoing prospective study with the aim to assess consequences of sarcopenia. MEASUREMENTS Muscle strength was evaluated with a hydraulic hand-dynamometer, appendicular lean mass and bone mineral density by Dual-Energy X-Ray Absorptiometry and physical performance by the Short Physical Performance Battery test (SPPB). Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People definition, i.e. a low muscle mass plus either low muscle strength or low physical performance. A bone mineral density T-score equal to or below -2.5SD at the lumbar spine, at the total hip or at the femoral neck was used to define osteoporosis (World Health Organization definition). RESULTS A total of 126 women aged 74.38±6.32 years were included. Among them, 26 were assessed with sarcopenia (20.6%) and 34 (27.0%) with osteoporosis. There were more osteoporotic women among sarcopenic subjects (46.1%) than among non-sarcopenic subjects (22.0%) (p-value=0.011). A significant lower appendicular lean mass index was observed in osteoporotic women (p-value=0.025). We also observed, in osteoporotic subjects, a lower muscle strength (p-value=0.023). Numerical values of bone mineral density were lower in the sarcopenic population but the differences did not reach the level of statistical significance. CONCLUSION Our study demonstrated that muscle mass and strength are lower in patients with osteoporosis. Prospective changes in bone and muscle mass will be investigated during the follow-up of our cohort.

Added value of a triaxial accelerometer assessing gait parameters to predict falls and mortality among nursing home residents: A two-year prospective study

BACKGROUND Gait impairment seems to be a risk factor for falls and mortality. Because gait change cannot be determined easily with classical clinical tests, some authors have suggested that it might be useful to use a gait-analysis system among elderly community-dwelling people. OBJECTIVE The main objective of the present study was to determine the predictive value of a quantitative evaluation of the gait characteristics in nursing home residents for the occurrence of falls and death performed using a tri-axial accelerometer (Locométrix®). MATERIAL AND METHODS One hundred elderly nursing home residents (80 women and 20 men, mean age 86.4 ± 6.04 years) were included in this study with the aim to follow them for 2 years. Deaths and falls were systematically recorded. A quantitative evaluation of a 10-second walk was performed with a tri-axial accelerometer (Locometrix®). Demographic data (i.e age, sex, body mass index) and clinical data (i.e. fall risk evaluated by the Tinetti test) were also recorded. RESULTS During the two years of follow-up, 27 patients died. After adjustment on all potential confounding variables, only body mass index was significantly associated with the risk of mortality with an odds ratio of 0.86 (95% CI: 0.77-0.96, p=0.04). At the end of the study period, 440 falls had occurred (mean: 4.44 ± 6.79 falls per patient) but no single factors were independently associated with fall incidence. CONCLUSION Our results show that a quantitative gait analysis performed using a tri-axial accelerometer is not predictive of long-term falls and mortality among nursing home residents.

Meeting the Needs of Mothers During the Postpartum Period: Using Co-Creation Workshops to Find Technological Solutions

Background The postnatal period is associated with many new needs for mothers. Objective The aim of this study was to find technological solutions that meet the needs of mothers during the year following childbirth. Methods Two co-creation workshops were undertaken with parents and professionals. The aim of the first workshop was to create a list of all the criteria the proposed solution would have to address to meet the needs of mothers after childbirth. The aim of the second workshop was to create solutions in response to the criteria selected during the first workshop. Results Parents and health professionals want solutions that include empathy (ie, to help fight against the feelings of abnormality and loneliness), that help mothers in daily life, that are personalized and adapted to different situations, that are educational, and that assures some continuity in their contact with health professionals. In practice, we found that parents and professionals think the solution should be accessible to everyone and available at all times. To address these criteria, technology experts proposed different solutions, such as a forum dedicated to the postpartum period that is supervised by professionals, a centralized website, a system of videoconferencing, an online exchange group, a “gift voucher” system, a virtual reality app, or a companion robot. Conclusions The human component seems to be very important during the postnatal period. Nevertheless, technology could be a great ally in helping mothers during the postpartum period. Technology can help reliably inform parents and may also give them the right tools to find supportive people. However, these technologies should be tested in clinical trials.

Identifying maternal needs following childbirth: A qualitative study among mothers, fathers and professionals

BackgroundPregnancy and childbirth are two critical stages in a woman’s life. Various studies have suggested that psychological distress is common during the year after childbirth. The objectives of this exploratory study were (1) to explore the needs of mothers in the year following childbirth; (2) to compare these needs between mothers who did not have the feeling of living a psychological disorder or a depression and mothers who lived a psychological disorder or had the impression of living a depression; and (3) to compare the needs expressed by mothers with the perception of professionals and fathers about the mothers’ needs.MethodsFirst, we proceeded to 22 individual qualitative interviews followed by one focus group, with mothers, with and without experience of psychological distress. Then, we conducted 2 focus groups: one with professionals and one with fathers.ResultsNeeds of mothers after childbirth have been indexed in four categories: need of information, need of psychological support, need to share experience, and need of practical and material support. Women do not feel sufficiently informed about this difficult period of life. They do not feel sufficiently supported, not only from a psychological point of view but also from a more practical point of view, for example with household chores. They need to share their experience of life, they need to be reassured and they need to feel understood. It seems that some differences exist between mothers’ and professionals’ experiences but also between mothers’ and fathers’ experiences.ConclusionYoung mothers apparently feel a lack of support at different levels in the year following childbirth. This study provides ways to meet women’s needs and to try to prevent the risk of postpartum psychological distress during this period of time.

P346: Prevalence of sarcopenia: the impact of different diagnostic cut-off limits

INTRODUCTION In the definition of the European Working Group on Sarcopenia in Older People (EWGSOP), different cut-off limits are proposed for appendicular lean mass, muscle strength and gait speed. Therefore we aimed to examine the variation in prevalence of sarcopenia obtained with these cut-off limits. MATERIALS AND METHODS Subjects aged 65 years and older were recruited in an outpatient clinic in Belgium and screened for sarcopenia using the EWGSOP definition. Appendicular lean mass was measured by Dual Energy X-Ray Absorptiometry, muscle strength by a hydraulic handgrip dynamometer and gait speed was measured on a 4-meter distance. Two different cut-off points proposed by the EWGSOP were examined for each variable and 8 diagnostic methods were thereby established. RESULTS 400 subjects were recruited for this study. Prevalence of sarcopenia varied from 9.25% to 18% depending on the cut-offs applied. When stratified by sex, it seems that the variation in prevalence of sarcopenia was mainly attributable to women. This prevalence ranged from 6.58% to 20.2% for women and only from 13.4% to 14.7% for men. CONCLUSION Prevalence of sarcopenia varies widely depending on the EWGSOP cut-off points applied for women. This may limit clinical researches and development of therapeutic strategies in the field of sarcopenia.