Monique M. Samson

Functional-task exercise versus resistance strength exercise to improve daily function in older women: A randomized, controlled trial

Objectives: To determine whether a functional‐task exercise program and a resistance exercise program have different effects on the ability of community‐living older people to perform daily tasks.

Evaluation of the applicability of HRT as a preservative of muscle strength in women

OBJECTIVESnTo review the studies that have been undertaken on the effects of postmenopausal hormone replacement therapy (HRT); especially oestrogen (+progestin) regimens on the preservation of muscle strength. Current knowledge of the mechanisms and actions of steroid- and sex hormones on skeletal muscle tissue will be used in an attempt to clarify the mechanism of action of a possible effect. The objective is to arrive at an agreement on whether or not postmenopausal oestrogen administration has a positive influence on skeletal muscle tissue.nnnMETHODSnPeer-reviewed publications were assessed.nnnRESULTSnAn age-related decrement in muscle strength can be found in both men and women. However, in women, an extra decline can be observed around the time of menopause. A possible relationship between the additional diminution in muscle strength and altered hormone concentrations after the onset of menopause has been suggested. Since women nowadays spend one-third of their life postmenopausal, it is extremely important to keep the decline in muscle mass as small as possible. Besides the continuation of a physically active lifestyle, HRT was suggested to serve as a protective mechanism. Although, the usefulness of HRT as a preservative of muscle strength appeared controversial.nnnCONCLUSIONSnSkeletal muscle strength is sensitive to training up to a high age, though continuation of physical activity does not appear to protect skeletal muscles completely from age-related decrements. Therefore, the development of another preventive method would be useful. Considering the present knowledge it has all the hallmarks that HRT can be a useful tool in the maintenance of muscle strength in postmenopausal women. None the less, further research is necessary to endorse this theory.

Relationship Between Circulating Levels of Sex Hormones and Insulin-Like Growth Factor-1 and Fluid Intelligence in Older Men

The relationship was investigated between baseline serum levels of total testosterone (T), free testosterone (FT), dehydroepiandrosterone sulfate (DHEAS), estradiol (E 2 ), sex hormone–binding globulin (SHBG), insulin-like growth factor-1 (IGF-1) and cognitive functioning in 25 healthy older men (mean age 69.1 years). Cognitive tests concerned measures not sensitive to aging (crystallized intelligence), and measures sensitive to aging (fluid intelligence and verbal long-term memory). Partial correlation coefficients (controlled for level of education) revealed significant associations of total T (r =- .52, p = .009), SHBG (r =- .59, p = .002) and IGF-1 (r = .54, p = .007) with the composite measure of fluid intelligence test performance, but not with crystallized intelligence, nor verbal long-term memory. Stepwise hierarchical regression analysis with the composite measure of fluid intelligence as the dependent variable showed that the contributions of SHBG, total T, and IGF-1 were not additive.The relationship was investigated between baseline serum levels of total testosterone (T), free testosterone (FT), dehydroepiandrosterone sulfate (DHEAS), ESTRADIOL (E2), sex hormone-binding globulin (SHBG), insulin-like growth factor-1 (IGF-1) and cognitive functioning in 25 healthy older men (mean age 69.1 years). Cognitive tests concerned measures not sensitive to ageing (crystallized intelligence), and measures sensitive to ageing (fluid intelligence and verbal long-term memory). Partial correlation coefficients (controlled for level of education) revealed significant associations of total T (r = -.52, p = -.009), SHBG (r - .59, p = .002) and IGF-1 (r = .54, p = .007) with the composite measure of fluid intelligence test performance, but not with crystallized intelligence, nor verbal long-term memory. Stepwise hierarchical regression analysis with the composite measure of fluid intelligence as the dependent variable showed that the contributions of SHBG, total T, and IGF-1 were not additive.

Raloxifene improves verbal memory in late postmenopausal women: a randomized, double-blind, placebo-controlled trial.

Objective: The aim of this study was to examine the effects of raloxifene compared with those of placebo on verbal memory, mental processing speed, depression, anxiety, and quality of life. Methods: A randomized, double-blind, placebo-controlled trial of 213 healthy women 70 years or older was conducted between July 2003 and January 2008 at the University Medical Centre Utrecht, the Netherlands. Participants were randomly assigned to receive raloxifene (60 mg) or placebo daily for 12 months. Measurements were taken at baseline and after 3, 6, and 12 months. The change in scores from baseline was calculated. The main outcome measures were direct and delayed verbal memory (Groningen 15 Words test), mental processing speed (Trails B test), mood/depression (Geriatric Depression Scale), anxiety (State-Trait Anxiety Inventory 1 and 2), and quality of life (Womens Health Questionnaire and EuroQol-5 dimensional questionnaire). Results: Direct verbal memory improved significantly with raloxifene compared with placebo: the women receiving raloxifene repeated more words in the words A + B test than did the women receiving placebo (P = 0.025). At 12 months, the change from baseline was 16 words in the raloxifene group and 10 words in the placebo group. In the words A test, direct repetition was also significantly better among women receiving raloxifene than among women receiving placebo (P = 0.023), with the change from baseline in the number of words repeated being nine words in the raloxifene group and six words in the placebo group at 12 months. Conclusions: In postmenopausal women, raloxifene gave significantly improved verbal memory when compared with placebo.

Muscle strength and tibolone: a randomised, double-blind, placebo-controlled trial

Objective To investigate the effects of tibolone, a tissue‐specific compound with a mixed (estrogenic, progestogenic and androgenic) hormonal profile, on skeletal muscle strength in a group of healthy postmenopausal women

Relationship between physical and cognitive function in healthy older men: a role for aerobic power?

they’re back at it again. Believe one working “down in the trenches”: this Guidance will result in a further exodus of physicians from nursing home practice. ‘The proposed guidelines are based on work done by Mark H. Beers and his committee.’ I disagree with their conclusions about several of the medications, but that is not really the point. It is the process and its implementation I must object to. For seven academic “experts” to devise a list of good medicines and bad medicines, and then for the federal government to endorse it hook, line, and sinker, and then to send armies of state employees to ferret out “inappropriate medications,” thereby forcing nursing homes to pester and antagonize their physicians, is ludicrous and appalling. If these seven men and the government feel so strongly about medications and nursing home practice, then let some government funds be spent collecting the opinions of a good thousand of us practicing “down in the trenches.” Can they really tell better than I who am at her bedside whether Mrs. McGillicutty is better off with or without her propoxyphene? And what about their caveat concerning beta-blockers in diabetics? At the annual American Geriatrics Society meeting several years ago, we had another expert inform us that HCFA was implementing a plan to track quality of care issues using HEDIS 3.0 and other scales. One of the parameters they were going to follow was whether a beta-blocker had been prescribed post myocardial infarct (good). After his lecture I asked about the use of beta-blockers in diabetics. The “expert” assured the audience that the fear of beta-blockers in diabetics was greatly exaggerated and dismissed it with a flip of his hand. Apparently the left hand doesn’t know what the right hand is doing! Please tell us, which cookbook are we to follow? I could go on and on about concerns and exceptions to several other medications they list as “bad” ask neurologists about ticlopidine versus aspirin in women, for example but I really am trying to keep this brief. I dare anyone to find another set of seven physicians who would agree with their conclusions about these particular medications. “These are only guidelines,” they will say. “We recognize there are exceptions.” Can you imagine the paperwork this will engender? The time? Do these seven men really believe they know better than I board-certified in internal medicine and geriatrics, with 20 years of primary care practice including 5 years of a practice comprising hundreds of nursing home patients, putting in 80+ hours of work a week, with call every third night, kept up sometimes all night long do they really think they know better than I which medications are right for each and every one of my patients? Get them off my back! Actually, I suspect these seven doctors would be the first to admit they do not know better. I know some of them almost personally from the annual meetings I attend. The culprits here are not these seven physicians but rather the government bureaucrats who will be sending mindless government robots out to “survey.” Dr. Beers himself said in the aforementioned article, “. . . has led to their application in ways that they were never intended to be used.” The same thing is happening all over again. Dr. Beers and colleagues mean well, but the government will see to it that we are pestered to death. The only ones left to practice in nursing homes will be passive incompetents who seek the warmth of being told exactly what to do. And can you imagine what the malpractice lawyers will do with this list of “bad medicines”! Please, I implore you, let these guidelines be scrapped.

Raloxifene and body composition and muscle strength in postmenopausal women: a randomized, double-blind, placebo-controlled trial

OBJECTIVEnTo compare the effects of raloxifene and placebo on body composition and muscle strength.nnnDESIGNnRandomized, double-blind, placebo-controlled trial involving 198 healthy women aged 70 years or older conducted between July 2003 and January 2008 at the University Medical Centre, Utrecht, The Netherlands.nnnMETHODSnParticipants were randomly assigned to receive raloxifene 60 mg or placebo daily for 12 months. Measurements were taken at baseline, 3, 6, and 12 months, and change from baseline was calculated. Main outcome measures were body composition (bioelectrical impedance analysis), muscle strength, and muscle power (maximum voluntary isometric knee extension strength, explosive leg extensor power, and handgrip strength).nnnRESULTSnAt 12 months, the body composition of women taking raloxifene was significantly different from that of women taking placebo: fat-free mass (FFM) had increased by a mean of 0.83 (2.4) kg in the raloxifene group versus 0.03 (1.5) kg in the placebo group (P=0.05), and total body water had increased by a mean of 0.6 (1.8) litres in the raloxifene group versus a decrease of 0.06 (1.1) litres in the placebo group (P=0.02). Muscle strength and power were not significantly different.nnnCONCLUSIONnRaloxifene significantly changed body composition (increased FFM; increased water content) compared with placebo in postmenopausal women.

Growth hormone release to Clonidine and the clinical response to Levodopa in Parkinsonism

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Welke training verbetert de ADL van relatief gezonde ouderen

Veroudering wordt gekenmerkt door achteruitgang in verschillende fysiologische domeinen, waaronder spierkracht, coordinatie, balans en cardiovasculair functioneren, met als cumulatief gevolg een verlies aan zelfstandig functioneren. Deelnemen aan een beweegprogramma wordt gezien als een effectieve methode om functionele beperkingen tijdens het ouder worden te voorkomen of te verminderen. Hoewel het effect van beweegprogramma’s voor ouderen op fysiologische uitkomstmaten uitgebreid beschreven en aangetoond is, is het effect op het uitvoeren van dagelijkse activiteiten niet duidelijk. In tegenstelling tot de gangbare beweegprogramma’s ontwikkelde het Universitair Medisch Centrum Utrecht een beweegprogramma voor ouderen dat voldoet aan de vier trainingsprincipes (overload, omkeerbaarheid, individualiteit en specificiteit). Dit trainingsprogramma voor functionele taken richt zich direct op de dagelijkse activiteiten die Nederlandse ouderen als het meest problematisch beschouwen. In een gerandomiseerde, gecontroleerde studie werd aangetoond dat het trainen van functionele taken meer effect heeft op het uitvoeren van dagelijkse taken door ouderen dan een spierversterkend trainingsprogramma. Daarnaast bleven de effecten van het functionele programma langer behouden na beeindiging van het programma, terwijl de winst in spierkracht zes maanden na beeindiging van het spierkrachtprogramma weer verdwenen was. Taakspecifiek trainen lijkt de voorkeur te hebben bij het trainen van ouderen met als doel het uitvoeren van dagelijkse activiteiten te verbeteren.