Device-specific weighted T-score for two quantitative ultrasounds: operational propositions for the management of osteoporosis for 65 years and older women in Switzerland.

The World Health Organization (WHO) criteria for the diagnosis of osteoporosis are mainly applicable for dual X-ray absorptiometry (DXA) measurements at the spine and hip levels. There is a growing demand for cheaper devices, free of ionizing radiation such as promising quantitative ultrasound (QUS). In common with many other countries, QUS measurements are increasingly used in Switzerland without adequate clinical guidelines. The T-score approach developed for DXA cannot be applied to QUS, although well-conducted prospective studies have shown that ultrasound could be a valuable predictor of fracture risk. As a consequence, an expert committee named the Swiss Quality Assurance Project (SQAP, for which the main mission is the establishment of quality assurance procedures for DXA and QUS in Switzerland) was mandated by the Swiss Association Against Osteoporosis (ASCO) in 2000 to propose operational clinical recommendations for the use of QUS in the management of osteoporosis for two QUS devices sold in Switzerland. Device-specific weighted "T-score" based on the risk of osteoporotic hip fractures as well as on the prediction of DXA osteoporosis at the hip, according to the WHO definition of osteoporosis, were calculated for the Achilles (Lunar, General Electric, Madison, Wis.) and Sahara (Hologic, Waltham, Mass.) ultrasound devices. Several studies (totaling a few thousand subjects) were used to calculate age-adjusted odd ratios (OR) and area under the receiver operating curve (AUC) for the prediction of osteoporotic fracture (taking into account a weighting score depending on the design of the study involved in the calculation). The ORs were 2.4 (1.9-3.2) and AUC 0.72 (0.66-0.77), respectively, for the Achilles, and 2.3 (1.7-3.1) and 0.75 (0.68-0.82), respectively, for the Sahara device. To translate risk estimates into thresholds for clinical application, 90% sensitivity was used to define low fracture and low osteoporosis risk, and a specificity of 80% was used to define subjects as being at high risk of fracture or having osteoporosis at the hip. From the combination of the fracture model with the hip DXA osteoporotic model, we found a T-score threshold of -1.2 and -2.5 for the stiffness (Achilles) determining, respectively, the low- and high-risk subjects. Similarly, we found a T-score at -1.0 and -2.2 for the QUI index (Sahara). Then a screening strategy combining QUS, DXA, and clinical factors for the identification of women needing treatment was proposed. The application of this approach will help to minimize the inappropriate use of QUS from which the whole field currently suffers.

Adjuvant chemotherapy in older women (ACTION) study - what did we learn from the pilot phase?

Despite widespread support at several public meetings, input from patient groups including representation on the Trial Management Group, the trial failed to recruit due to the inability to convince patients to accept randomisation. It would therefore seem that randomising the patients to receive chemotherapy vs observation is not a viable design in the current era for this patient population.

Bacillus coagulans GBI-30, 6086 modulates Faecalibacterium prausnitzii in older men and women

Abstract Background: Advancing age is linked to a decrease in beneficial bacteria such as Bifidobacterium spp. and reduced aspects of innate immune function. Objectives: We investigated whether daily consumption of a probiotic [Bacillus coagulans GBI-30, 6086 (BC30); GanedenBC30] could improve immune function and gut function in men and women aged 65–80 y, using a double-blind, placebo-controlled crossover design. Method: Thirty-six volunteers were recruited and randomly assigned to receive either a placebo (microcrystalline cellulose) or the probiotic BC30 (1 3 109 colony-forming units/capsule). Volunteers consumed 1 treatment capsule per day for 28 d, followed by a 21-d washout period before switching to the other treatment. Blood and fecal samples were collected at the beginning and end of each treatment period. Fecal samples were used to enumerate bacterial groups and concentrations of calprotectin. Peripheral blood mononuclear cells (PBMCs) were extracted from whole blood to assess natural killer cell activity and lipopolysaccharide (LPS)-stimulated cytokine production. C-reactive protein concentrations were measured in plasma. Results: Consumption of BC30 significantly increased populations of Faecalibacterium prausnitzii by 0.1 log10 cells/mL more than during consumption of the placebo (P = 0.03), whereas populations of Bacillus spp. increased significantly by 0.5 log10 cells/mL from baseline in volunteers who consumed BC30 (P = 0.007). LPS-stimulated PBMCs showed a 0.2 ng/mL increase in the anti-inflammatory cytokine IL-10 28 d after consumption of BC30 (P < 0.05), whereas the placebo did not affect IL-10, and no overall difference was found in the effect of the treatments. Conclusions: Daily consumption of BC30 by adults aged 65–80 y can increase beneficial groups of bacteria in the human gut and potentially increase production of anti-inflammatory cytokines. This study shows the potential benefits of a probiotic to improve dysbiosis via modulation of the microbiota in older persons. J Nutr doi: 10.3945/jn.114.199802.

Cardiovascular fitness and cardiovascular risk factors among obese men and women aged 58 years and older, in Portugal

Background: A better physical fitness may have survival advantages in adults. Aim: To analyze the relationship between cardiorespiratory fitness and cardiovascular risk factors among obese subjects aged 58 years and older. Material and Methods: Cardiorespiratory fitness using the six-minute walk test, body composition by dual-energy x-ray absorptiometry and blood pressure were measured in a non-representative sample of 76 obese Portuguese subjects aged 58 to 87 years (55 women). Participants were stratified in tertiles of walking capacity according to the six-minute walk test. Results: Six minutes walk test results were negatively correlated with percentage body fat (r = -0.28; p = 0.012) and systolic blood pressure (r = -0.23; p = 0.045). Participants located in the lowest tertile for the six minutes walk test had an odds ratio of 4.34 (95% confidence intervals: 1.02-18.43) for elevated blood pressure. Conclusions: A lower six minutes walk test result is associated with a higher risk for high blood pressure. (Rev Med Chile 2012; 140: 1164-1169).

An explanatory mechanism for the different decline in limb strength in older women

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Effect of Strength Training on Rate of Force Development in Older Women

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

ACUTE EFFECT of STATIC STRETCHING on RATE of FORCE DEVELOPMENT and MAXIMAL VOLUNTARY CONTRACTION IN OLDER WOMEN

Gurjao, ALD, Goncalves, R, de Moura, RF, and Gobbi, S. Acute effect of static stretching on rate of force development and maximal voluntary contraction in older women. J Strength Cond Res 23(7): 2149-2154, 2009-The purpose of this study was to investigate, in older women, the acute effect of static stretching (SS) on both muscle activation and force output. Twenty-three older women (64.6 +/- 7.1 yr) participated in the study. The maximal voluntary contraction (MVC), rate of force development (RFD) (50, 100, 150, and 200 ms relative to onset of muscular contraction), and peak RFD (PRFD) (the steepest slope of the curve during the first 200 ms) were tested under 2 randomly separate conditions: SS and control (C). Electromyographic (EMG) activity of the vastus medialis (VM), vastus lateralis (VL), and biceps femoris (BF) muscles also was assessed. The MVC was significantly lower (p < 0.05) in the 3 trials of SS when compared with the C condition (control: 925.0 +/- 50.9 N; trial 1 : 854.3 +/- 55.3 N; trial 2 : 863.1 +/- 52.2 N; and trial 3 : 877.5 +/- 49.9 N). PRFD showed a significant decrease only for the first 2 trials of SS when compared with the C condition (control: 2672.3 +/- 259.1 N/s; trial 1 : 2296.6 +/- 300.7 N/s; and trial 2 : 2197.9 +/- 246.3 N/s). However, no difference was found for RFD (50, 100, 150, and 200 ms relative to onset of muscular contraction). The EMG activity for VM, VL, and BF was not significantly different between the C and SS conditions. In conclusion, the older women's capacity to produce muscular force decreased after their performance of SS exercises. The mechanisms responsible for this effect do not appear to be related to muscle activation. Thus, if flexibility is to be trained, it is recommended that SS does not occur just before the performance of activities that require high levels of muscular force.

Effect of different rest intervals, between sets, on muscle performance during leg press exercise, in trained older women

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Long-term creatine supplementation improves muscular performance during resistance training in older women

This study examined the effects of long-term creatine supplementation combined with resistance training (RT) on the one-repetition maximum (1RM) strength, motor functional performance (e.g., 30-s chair stand, arm curl, and getting up from lying on the floor tests) and body composition (e.g., fat-free mass, muscle mass, and % body fat using DEXA scans) in older women. Eighteen healthy women (64.9 ± 5.0 years) were randomly assigned in a double-blind fashion to either a creatine (CR, N = 9) or placebo (PL, N = 9) group. Both groups underwent a 12-week RT program (3 days week-1), consuming an equivalent amount of either creatine (5.0 g day-1) or placebo (maltodextrin). After 12 week, the CR group experienced a greater (P < 0.05) increase (Δ%) in training volume (+164.2), and 1RM bench press (+5.1), knee extension (+3.9) and biceps curl (+8.8) performance than the PL group. Furthermore, CR group gained significantly more fat-free mass (+3.2) and muscle mass (+2.8) and were more efficient in performing submaximal-strength functional tests than the PL group. No changes (P > 0.05) in body mass or % body fat were observed from pre- to post-test in either group. These results indicate that long-term creatine supplementation combined with RT improves the ability to perform submaximal-strength functional tasks and promotes a greater increase in maximal strength, fat-free mass and muscle mass in older women. © 2012 Springer-Verlag Berlin Heidelberg.

The acute effects of static stretching on peak force, peak rate of force development and muscle activity during single- and multiple-joint actions in older women

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Motor readiness and joint torque production in lower limbs of older women fallers and non-fallers

This study aimed to evaluate the motor response time and ability to develop joint torque at the knee and ankle in older women with and without a history of falls, in addition to investigating the effect of aging on these capacities. We assessed 18 young females, 21 older female fallers and 22 older female non-fallers. The peak torque, rate of torque development, rate of electromyography (EMG) rise, reaction time, premotor time and motor time were obtained through a dynamometric assessment and simultaneous electromyography. Surface EMGs of the rectus femoris (RF), vastus lateralis (VL), biceps femoris (BF), gastrocnemius lateralis (GL) and tibialis anterior (TA) muscles were recorded. Knee extension and flexion peak torques were lower in older fallers than in non-fallers. Knee extension and flexion and ankle plantarflexion and dorsiflexion peak torques were lower in both older groups than in the younger group. The rate of EMG rise of the BF and the motor time of the TA were lower and higher, respectively, in older fallers than in the younger adults. The time to reach peak torque in knee extension/flexion and ankle plantarflexion/dorsiflexion and the motor times of the RF, VL, BF and GL were higher in both older groups than in the younger groups. The motor time of the TA during ankle dorsiflexion and the knee extension peak torque were the major predictors of falls in older women, accounting for approximately 28% of the number of falls. Thus, these results further reveal the biomechanical parameters that affect the risk of falls and provide initial findings to support the prescription of exercises in fall prevention programs. © 2013 Elsevier Ltd.