Pedro R. Olivares

Prevalence of overweight and obesity in non-institutionalized people aged 65 or over from Spain: the elderly EXERNET multi-centre study

Coupled with the growth of the older population, an increase in the prevalence of overweight and obesity in this age group has occurred in the last decades. The main aims of the present study were (i) to provide an updated prevalence of overweight and obesity in a representative sample of the Spanish elderly population; (ii) to calculate the prevalence of sarcopenic obesity (SO) and (iii) to analyse the relationships between adiposity measurements and lifestyle. A cross‐sectional study was carried out in a sample of 3136 persons representative of the non‐institutionalized population ≥65 years of age. Anthropometric measurements were obtained using standardized techniques and equipment. Overall, 84% of the population can be categorized as overweight and/or obese. The present study indicates that 67% of the Spanish elderly population has an increased percentage of fat mass and more than 56% suffer from central obesity. Moreover, SO is present in 15% of the Spanish elderly population. Finally, a strong relationship between both physically active and sedentary lifestyles and the level of adiposity was found. Prevalence of overweight and obesity among elderly people in Spain is very high and is still increasing. Lifestyle seems to be a determinant factor in the development of obesity among elderly people.

Balance training reduces fear of falling and improves dynamic balance and isometric strength in institutionalised older people: a randomised trial

QUESTION What is the effect of a balance training protocol with the Biodex Balance System in institutionalised older people with fear of falling? DESIGN Randomised controlled trial with concealed allocation and assessor blinding. PARTICIPANTS Forty older people who lived in a nursing home and had fear of falling. INTERVENTION The experimental group completed a 12-week balance training protocol based on balancing/rebalancing training with the Biodex Balance System, with two sessions per week. During the training period, participants in both groups received the same multidisciplinary care (such as physiotherapy, occupational therapy and nursing) that they usually received in the nursing home. OUTCOME MEASURES The primary outcome was fear of falling (Falls Efficacy Scale International questionnaire). Secondary outcomes were dynamic balance (Fall Risk Test) and isometric strength (torque of knee flexor and extensor isometric strength measured with an isokinetic dynamometer). Outcome measures were taken before and after the training program protocol. RESULTS Compared to the control group, the exercise group had significantly greater improvements at 12 weeks in fear of falling (by 8 points, 95% CI 4 to 12), in dynamic balance (by 2 degrees, 95% CI 1 to 3), and in isometric strength of the knee flexors (by 7Nm, 95% CI 3 to 11) and knee extensors (by 7Nm, 95% CI 1 to 13). CONCLUSION The training program was feasible and effective in reducing fear of falling and improving dynamic balance and isometric strength in institutionalised older people with fear of falling. TRIAL REGISTRATION ISRCTN21695765.

Using whole-body vibration training in patients affected with common neurological diseases: a systematic literature review.

OBJECTIVES This systematic review critically evaluates the effects of whole body vibration (WBV) exercises on gait, balance, proprioception, strength, and health-related quality of life in patients with common neurological diseases. It specifically focuses on assessing the quality of reported studies and comparing quantitative results. DESIGN This is a systematic literature review. RESULTS A specific search strategy of 11 databases identified 13 published articles (5 studies of patients with Parkinson disease, 2 with cerebral palsy, 3 with multiple sclerosis, and 3 with stroke) that fulfilled the selection criteria. The quality of the articles was evaluated using a Physiotherapy Evidence Database scale and Dutch Institute for Healthcare Improvement guidelines. CONCLUSIONS There is moderate evidence that one session of WBV has positive effects on strength, whereas there is a weak level of evidence that WBV could improve proprioception and health-related quality of life measures in neurological patients. With respect to long-term effects of WBV, there is minor evidence from the studies with the best methodological quality that WBV improves strength, proprioception, gait, and balance. Further research on the intervention is strongly needed.

Fitness and health-related quality of life dimensions in community-dwelling middle aged and older adults

BackgroundThe aim of the present study was to identify the physical fitness (PF) tests of a multi-component battery more related to the perception of problems in each dimension of the health-related quality of life (HRQoL) assessed by the EuroQol 5 dimensions 3 level questionnaire (EQ-5D-3L) in community-dwelling middle-aged and older adultsMethodsA cross-sectional study was conducted with 7104 participants (6243 females and 861 males aged 50-99 years) who were recruited in the framework of the Exercise Looks After You Program, which is a public health program designed to promote physical activity (PA) in community-dwelling middle-aged and older adults. Participants were assessed by the EQ-5D-3L questionnaire and a battery of fitness tests. The responses to each EQ-5D-3L dimension were collapsed into a two-tier variable consisting of «perceive problems» and «do not perceive problems». Correlation coefficients for the relationships between the HRQoL variables, between the PF variables, and between the HRQoL and PF variables were obtained. Two logistic regression models, one adjusted and one unadjusted, were developed for each EQ-5D-3L dimension.ResultsThere were significant correlations between all variables except anxiety/depression and the back scratch test. The PF tests that correlated best with the HRQoL dimensions were the Timed Up-and-Go Test (TUG) and the 6-min walk; pain/discomfort and anxiety/depression correlated less well. All PF tests correlated, especially the TUG and 6-min walk tests. Unadjusted logistic models showed significant goodness of fit for the mobility and pain/discomfort dimensions only. Adjusted logistic models showed significant goodness of fit for all dimensions when the following potential confounding variables were included: age, gender, weekly level of PA, smoking and alcohol habits, body mass index, and educational level. For all dimensions, the highest odds ratios for the association with PF tests were with the TUG; this was observed with both the unadjusted and adjusted models.ConclusionsThe perception of problems, as measured by the EQ-5D-3L dimensions, was associated with a lower level of fitness, particularly for those dimensions that relate more closely to physical components. The PF tests that associated most closely with the perception of problems in the HRQoL dimensions were the TUG and the 6-min walk. This information will aid the design and assessment of PA programs that aim to improve HRQoL.

Sitting time increases the overweight and obesity risk independently of walking time in elderly people from Spain.

INTRODUCTION Obesity, defined as an excess of total body fat, is a matter of concern all over the world, and its prevalence is still increasing among elderly people. OBJECTIVES To examine whether sedentary behaviour (hours sitting per day) is associated with higher risk of central obesity, overweight-obesity and overfat in a representative sample of non-institutionalized Spanish elderly population and if so, whether hours walking per day modified this association. STUDY DESIGN A cross-sectional study in a sample of 3136 people ≥65 years of age. MAIN OUTCOMES MEASURES Anthropometric measurements were obtained using standardized techniques and equipment. Active and sedentary behaviours were recorded by questionnaire. RESULTS For both men and women, the higher prevalence of overweight-obesity, central obesity and overfat was found in those who spent sitting more than 4h per day and walk less than 1h, compared with those who spent sitting less than 4h per day and walk more than 1h (all p<0.001, except for central obesity in women). In men, more than 4h sitting per day was associated with 1.7-fold higher odds of having central obesity compared with those sitting less than 4h per day (p<0.01). In women, this sedentary behaviour increased the risk of overweight-obesity and overfat by 1.5 and 1.4, respectively (p<0.01). Age or time spent walking did not significantly change these results. CONCLUSION Sitting time increases the risk of overweight-obesity and overfat in women and the risk of central obesity in men, independently of walking time.

The Spanish version of the ''STarT Back Screening Tool'' (SBST) in different subgroups

OBJECTIVE The aim of this study was to translate and culturally adapt the original version of the STarT Back Screening Tool (SBST) to Spanish for different population subgroups. DESIGN Translation and cultural adaptation of a questionnaire. SETTING Primary care settings. METHOD Thirty-eight people distributed by: gender; adults and elderly; and with or without pain. Phases: a) Forward translation (English-Spanish); b) Evaluation of the clarity, the acceptability and the familiarity of the content of the obtained Spanish version by means of cognitive interviews to participants, and c) Translation of the final Spanish version of the questionnaire back into the original language. RESULTS The participants interviewed indicated that most of the items of the questionnaire were clear and comprehensible, showing greater difficulty in understanding in the dimensions of disability and anxiety. Furthermore, the questionnaire was more difficult to understand by the elderly and patients with a previous non-specific low back pain episode. CONCLUSION The Spanish version of the SBST questionnaire was obtained, which was shown to be comprehensible and adapted to the general population in Spain. Due to being short and easy to use, it is a potentially useful tool for use in primary care.

Tilt vibratory exercise and the dynamic balance in fibromyalgia: A randomized controlled trial.

To evaluate the feasibility and efficacy of tilt whole‐body vibration (WBV) for improving dynamic balance in women with fibromyalgia (FM).

Tilting Whole Body Vibration improves quality of life in women with fibromyalgia: a randomized controlled trial.

OBJECTIVES The aim of this study was to analyze the effect of 12-week tilting Whole Body Vibration therapy (WBV) on Health Related Quality of Life (HRQoL) in fibromylagia (FM) within the context of a randomized control trial (ISRCTN16950947). SUBJECTS AND METHODS Thirty-six (36) women with FM were randomly allocated to either an exercise or a control group. The women in the exercise group were assigned to a 12-week course of tilting WBV (12.5-Hz frequency; 3-mm amplitude). HRQoL was assessed using the Fibromyalgia Impact Questionnaire (FIQ) and a 15D questionnaire. RESULTS A 12-week course of tilting WBV therapy was associated with improvements in FIQ scores (12%) but not in the 15D questionnaire. CONCLUSIONS Tilting WBV was a feasible intervention that prevented the loss of HRQoL in previously physically untrained women with FM.

Test-Retest Reliability of Isometric and Isokinetic Knee Extension and Flexion in Patients With Fibromyalgia: Evaluation of the Smallest Real Difference

OBJECTIVE To investigate the reliability of isokinetic peak torque and work and isometric peak torque measurements for knee flexion and extension in fibromyalgia (FM) patients by determining the smallest real difference (SRD). DESIGN Test-retest reliability study. SETTING University laboratory. PARTICIPANTS Women with FM (N=37) aged between 34 and 74 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The participants performed isometric, concentric, and eccentric tests of the knee. Unilateral maximal peak torque and average work were measured for each direction (flexion, extension) and contraction (isometric, concentric, eccentric) type. Relative reliability, absolute reliability, and SRD were calculated. The 3 tests were repeated after an interval of 7 days. RESULTS With the exception of eccentric flexion, all peak torque measures had an intraclass correlation coefficient (ICC) of > 0.90, and all work measures had an ICC of > 0.85. The SRD ranged between 21% and 37% for all peak torque measures and between 40% and 73% for all work measures. CONCLUSIONS Isokinetic dynamometry provides reliable measurement of peak torque and work for isometric, concentric, and eccentric knee flexion and extension in patients with FM. The present study has generated novel SRD data, which will assist physicians, therapists, and clinicians in interpreting posttreatment changes in patients with FM.

Harmonization process and reliability assessment of anthropometric measurements in the elderly EXERNET multi-centre study.

Background The elderly EXERNET multi-centre study aims to collect normative anthropometric data for old functionally independent adults living in Spain. Purpose To describe the standardization process and reliability of the anthropometric measurements carried out in the pilot study and during the final workshop, examining both intra- and inter-rater errors for measurements. Materials and Methods A total of 98 elderly from five different regions participated in the intra-rater error assessment, and 10 different seniors living in the city of Toledo (Spain) participated in the inter-rater assessment. We examined both intra- and inter-rater errors for heights and circumferences. Results For height, intra-rater technical errors of measurement (TEMs) were smaller than 0.25 cm. For circumferences and knee height, TEMs were smaller than 1 cm, except for waist circumference in the city of Cáceres. Reliability for heights and circumferences was greater than 98% in all cases. Inter-rater TEMs were 0.61 cm for height, 0.75 cm for knee-height and ranged between 2.70 and 3.09 cm for the circumferences measured. Inter-rater reliabilities for anthropometric measurements were always higher than 90%. Conclusion The harmonization process, including the workshop and pilot study, guarantee the quality of the anthropometric measurements in the elderly EXERNET multi-centre study. High reliability and low TEM may be expected when assessing anthropometry in elderly population.