Meng-Yueh Chien

Prevalence of Sarcopenia Estimated Using a Bioelectrical Impedance Analysis Prediction Equation in Community-Dwelling Elderly People in Taiwan

OBJECTIVES: To compare a bioelectrical impedance analysis (BIA) prediction equation for estimating skeletal muscle mass (SM) with magnetic resonance imaging (MRI)‐measured SM and to investigate the prevalence of sarcopenia in community‐dwelling elderly people in Taiwan.

Exercise training improves sleep quality in middle-aged and older adults with sleep problems: a systematic review

QUESTION Does an exercise training program improve the quality of sleep in middle-aged and older adults with sleep problems? DESIGN Systematic review with meta-analysis of randomised trials. PARTICIPANTS Adults aged over 40 years with sleep problems. INTERVENTION A formal exercise training program consisting of either aerobic or resistance exercise. OUTCOME MEASURES Self-reported sleep quality or polysomnography. RESULTS Six trials were eligible for inclusion and provided data on 305 participants (241 female). Each of the studies examined an exercise training program that consisted of either moderate intensity aerobic exercise or high intensity resistance exercise. The duration of most of the training programs was between 10 and 16 weeks. All of the studies used the self-reported Pittsburgh Sleep Quality Index to assess sleep quality. Compared to the control group, the participants who were randomised to an exercise program had a better global Pittsburgh Sleep Quality Index score, with a standardised mean difference (SMD) of 0.47 (95% CI 0.08 to 0.86). The exercise group also had significantly reduced sleep latency (SMD 0.58, 95% CI 0.08 to 1.08), and medication use (SMD 0.44, 95% CI 0.14 to 0.74). However, the groups did not differ significantly in sleep duration, sleep efficiency, sleep disturbance, or daytime functioning. CONCLUSION Participation in an exercise training program has moderately positive effects on sleep quality in middle-aged and older adults. Physical exercise could be an alternative or complementary approach to existing therapies for sleep problems.

Efficacy of a 24-Week Aerobic Exercise Program for Osteopenic Postmenopausal Women

Abstract. Osteoporosis is one of the most common skeletal disorders affecting postmenopausal women. The purpose of this study was to investigate whether a 24-week program of aerobic high-impact loading exercise was beneficial for enhancing physical fitness and bone mineral density (BMD) in osteopenic postmenopausal women. Forty-three postmenopausal women aged 48–65 years participated in this study. The BMD of the spine (L2–L4) and right femoral neck of each woman was below 1 SD of the mean of premenopausal women, as examined by dual X-ray absorptiometry. The assignment of subjects into exercise or control group was not randomized but based on each subjects anticipated compliance to the 6-month long exercise program. Twenty-two subjects joined the exercise group and attended the training programs and 21 served as the control group. Exercise programs included treadmill walking at an intensity above 70% of maximal oxygen consumption (VO2max) for 30 minutes, followed by 10 minutes of stepping exercise using a 20-cm-high bench. The program was conducted three times per week for 24 weeks. Physical fitness measurements included testing of flexibility, muscular strength and endurance, body composition, and cardiopulmonary fitness. The results showed that the quadriceps strength, muscular endurance, and VO2max in the exercise group had significant improvements, whereas no improvement was found in any of the physical fitness parameters in the control group. The BMD of the L2–L4 and the femoral neck in the exercise group increased 2.0% (P > 0.05) and 6.8% (P < 0.05) and those in the control group decreased 2.3% (P < 0.05) and 1.5% (P > 0.05), respectively. In conclusion, aerobics combined with high-impact exercise at a moderate intensity was effective in offsetting the decline in BMD in osteopenic postmenopausal women.

Sarcopenia, Cardiopulmonary Fitness, and Physical Disability in Community-Dwelling Elderly People

Background Sarcopenia refers to the loss of skeletal muscle mass with aging. It is believed to be associated with functional impairment and physical disability. Objective The purposes of this study were: (1) to compare the physical activity, muscle strength (force-generating capacity), cardiopulmonary fitness, and physical disability in community-dwelling elderly people with sarcopenia, borderline sarcopenia, and normal skeletal muscle mass in Taiwan and (2) to test the hypothesis that sarcopenia is associated with physical disability and examine whether the association is mediated by decreased muscle strength or cardiopulmonary fitness. Design This was a cross-sectional investigation. Methods Two hundred seventy-five community-dwelling elderly people (148 men, 127 women) aged ≥65 years participated in the study. The participants were recruited from communities in the district of Zhongzheng, Taipei. Predicted skeletal muscle mass was estimated using a bioelectrical impedance analysis equation. The skeletal muscle mass index (SMI) was calculated by dividing skeletal muscle mass by height squared. Physical disability was assessed using the Groningen Activity Restriction Scale. Physical activity was assessed using a 7-day recall physical activity questionnaire. Cardiopulmonary fitness was assessed using a 3-minute step test, and grip strength was measured to represent muscle strength. Results Cardiopulmonary fitness was significantly lower in elderly people with sarcopenia than in those with normal SMIs. Grip strength and daily energy expenditure (kcal/kg/day) were not significantly different between the participants with sarcopenia and those with normal SMIs. The odds ratio for physical disability between the participants with sarcopenia and those with normal SMIs was 3.03 (95% confidence interval=1.21–7.61). The odds ratio decreased and the significant difference diminished after controlling for cardiopulmonary fitness. Limitations A causal relationship between sarcopenia and physical activity, cardiopulmonary fitness, and physical disability cannot be established because of the cross-sectional nature of study design. Conclusions Sarcopenia was associated with physical disability in elderly men. The association between sarcopenia and physical disability was mediated to a large extent by decreased cardiopulmonary fitness.

Home-based trunk-strengthening exercise for osteoporotic and osteopenic postmenopausal women without fracture –a pilot study

Objectives: To investigate whether a 12-week home-based programme of trunk-strengthening exercise could benefit spinal mobility, function and quality of life for osteoporotic and osteopenic postmenopausal women without fracture. Designs: Randomized controlled clinical trial. Setting: Department of Physical Therapy in National Taiwan University Hospital. Subjects: Twenty-eight postmenopausal women (mean age 60.39=9.3 years) diagnosed with osteoporosis or osteopenia without fracture history were recruited for this study. Subjects were randomly assigned into exercise or control groups, each consisting of 14 subjects. Interventions: The 12-week exercise programme included strengthening routines for the trunk extensor and flexor muscles. The subjects performed three sets of 10 repetitions for each of the exercises, with programmes carried out three times per day at home. Main outcome measurements: Muscular strength, spinal range of motion (ROM) and motion velocity, Oswestry Disability Questionnaire (ODQ) and quality of life (QOL) were measured before the start and after completion of the exercise programme. Results: Statistically significant improvements were demonstrated in spinal ROM and motion velocity in the sagittal and frontal planes for the exercise group (pB=0.05). Further, the strength of the trunk flexors and extensors increased after exercise training (pB=0.05). ODQ measure was significantly reduced in the exercise group (pB=0.05), while the controls showed no significant change. Subjects in the exercise group showed better satisfaction in some domains of the Short-Form-36 Health Survey quality of life questionnaire (pB=0.05). Conclusions: This 12-week home-based trunk-strengthening exercise programme could improve trunk mobility and strength, and enhance QOL in osteoporotic and osteopenic postmenopausal women without vertebral fracture. Future study should recruit more cases or more severe subjects to verify the results.

Spinal Performance and Functional Impairment in Postmenopausal Women with Osteoporosis and Osteopenia without Vertebral Fracture

Abstract:Previous studies have paid much attention to the impact on functional impairment or quality of life from vertebral fractures secondary to osteoporosis, but little research has addressed the function of osteoporotic women without fractures. The purposes of this study were: (1) to describe spinal performance and functional impairment in postmenopausal women with osteoporosis and osteopenia without vertebral fracture, and (2) to investigate the relationship between them. Thirty postmenopausal women diagnosed as having osteoporosis or osteopenia were recruited who fulfilled the following criteria: (1) menopause for at least 6 months; (2) no vertebral fracture; (3) no medication that would interfere with calcium intake. Measurements included assessment of functional impairment and spinal performance including trunk extension/flexion isokinetic strength, spinal range of motion (ROM) and movement velocity in three planes (sagittal, frontal and transverse). The results showed that spinal ROM and velocity were significantly reduced in the osteoporosis group compared with the osteopenia group (p<0.05), but no significant difference in trunk strength was shown. Functional impairment level showed a slight difference between the two groups (p= 0.042). There was a significant correlation between spinal ROM and motion velocity with bone mineral density; however, functional impairment correlated with motion velocity only in the transverse plane (trunk rotation) (p<0.05). Spinal strength did not show any correlation with other parameters. It was concluded that spinal motion performance declined and functional impairment increased in relation to the severity of bone mineral loss in postmenopausal women without vertebral fracture, but their physical performance was not correlated with functional impairments.

Inspiratory muscle dysfunction in patients with severe obstructive sleep apnoea

Repetitive inspiratory effort against an obstructed airway and intermittent hypoxia may be deleterious to the inspiratory muscles in patients with obstructive sleep apnoea (OSA). We investigated muscular dysfunction by comparing the strength, endurance and fatigability of inspiratory muscles and knee extensors in patients with newly diagnosed severe OSA compared with matched controls. The measurements included strength and endurance tests of both muscles, and a fatigue trial with simultaneous surface electromyography of the diaphragm and the vastus lateralis during voluntary contractions and in response to magnetic stimulation. To our knowledge, this is the first investigation to assess peripheral muscle performance in severe OSA patients versus controls. Patients in the OSA group exhibited significantly lower strength and endurance in both muscles than the control group. The fatigue index decreased significantly exclusively in the inspiratory muscles of OSA patients. Magnetic stimulation-evoked compound muscle action potential latencies increased and the amplitudes decreased significantly in the diaphragm, but not in the vastus lateralis after a fatigue test in the OSA group. In conclusion, a significantly lower functional performance was shown for both inspiratory muscles and knee extensors in the OSA group. However, higher fatigability was only seen in the inspiratory muscles of patients with severe OSA.

Effects of Exercise Training on Autonomic Function in Chronic Heart Failure: Systematic Review.

Objectives. Cardiac autonomic imbalance accompanies the progression of chronic heart failure (CHF). It is unclear whether exercise training could modulate autonomic control in CHF. This study aimed to review systematically the effects of exercise training on heart rate recovery (HRR) and heart rate variability (HRV) in patients with CHF. Methods. Literatures were systematically searched in electronic databases and relevant references. Only published randomized controlled trials (RCTs) focusing on exercise training for CHF were eligible for inclusion. Outcome measurements included HRR and HRV parameters. Results. Eight RCTs were eligible for inclusion and provided data on 280 participants (186 men). The participants were 52–70 years of age with New York Heart Association functional class II-III of CHF. Each study examined either aerobic or resistance exercise. Two trials addressed outcome of HRR and six HRV among these studies. Two RCTs showed that moderate aerobic exercise could improve HRR at 2 minutes after exercise training in CHF. Five of six RCTs demonstrated positive effects of exercise training on HRV which revealed the increments in high frequency (HF) and decrements in LF (low frequency)/HF ratio after training. Conclusion. Participation in an exercise training program has positive effects on cardiac autonomic balance in patients with CHF.

Poor Sleep Quality is Independently Associated with Physical Disability in Older Adults

STUDY OBJECTIVE We aimed to evaluate the association between sleep quality and physical disability in community-dwelling older adults. METHODS There were 213 community-dwelling adults (76 men and 137 women) aged 65 years and above participated into this investigation. The Groningen Activity Restriction Scale and the Pittsburgh Sleep Quality Index were utilized to evaluate physical disability and subjective sleep quality, respectively. Global functional capacity was measured by the 6-minute walk test (6MWT). The Mini Mental State Examination and the Chinese Geriatric Depression Screening Scale were used to evaluate cognitive function and depression. RESULTS Univariate analysis revealed a correlation between physical disability and poor sleep quality, older age, 2 or more comorbidities, depression, functional capacity, and poor cognitive function. However, in the multivariate analyses, depression failed to show significant association with physical disability. In contrast, an independent association was observed between poor sleep quality and physical disability (OR = 2.03; 95% CI: 1.02-4.05). CONCLUSIONS In community-dwelling older adults, subjective poor sleep was significantly associated with physical disability, even after controlling for the effects of other established risk factors.

The Relationship of Sleep Duration with Obesity and Sarcopenia in Community-Dwelling Older Adults

Background: Numerous studies have reported the relationship between sleep duration and obesity in elderly adults; however, little is known about the relationship of sleep duration and sarcopenia. Objective: We examined the relationship of sleep duration with obesity and sarcopenia in community-dwelling older adults. Methods: A total of 488 community-dwelling adults (224 men and 264 women) aged ≥65 years were included in the analysis. Self-reported sleep duration and anthropometric data were collected. Skeletal muscle mass was estimated using the predicted equation from a bioelectrical impedance analysis measurement. Obesity and sarcopenia were defined according to the body mass index and the skeletal muscle mass index, respectively. Results: The association between sleep duration and sarcopenia exhibited a U shape in older adults. Compared to adults with 6-8 h of sleep, adults with <6 h of sleep had a nearly 3-fold increased likelihood of sarcopenia (odds ratio, OR: 2.76, 95% confidence interval, CI: 1.28-5.96), while adults with ≥8 h of sleep had a nearly 2-fold increased risk of sarcopenia (OR: 1.89, 95% CI: 1.01-3.54). Older adults with a sleep duration <6 h were more prone to obesity (OR: 2.15, 95% CI: 1.08−4.30). After gender stratification, the association between obesity and short sleep duration was more robust in women. Conclusion: There were significant associations of sleep duration with either obesity or sarcopenia in community-dwelling older adults. Gender differences in these associations were also observed.