Biomedical subjects

Jack M Guralnik

Publications and source records attributed to Jack M Guralnik.

At least 19 recordsLinked to original sources

PubMed2007

Age-associated declines in complex walking task performance: the Walking InCHIANTI toolkit.

OBJECTIVES: To describe a set of complex walking tasks (CWTs) that can be used to evaluate mobility and to characterize age- and sex-specific performance on these tests. DESIGN: A population-based study of persons living in the Chianti geographic area (Tuscany, Italy). SETTING: Community. PARTICIPANTS: One thousand two hundred twenty-seven persons (aged 20-95) selected from the city registries of Greve and Bagno a Ripoli (Tuscany, Italy). MEASUREMENTS: Gait velocity (m/s) was measured during 13 walking tests (Walking InCHIANTI Toolkit (WIT)) used to examine walking ability under a range of conditions and distances. Other measures included performance on the Short Physical Performance Battery and self-reported health and functional status, including disability in activities of daily living. RESULTS: Age-associated differences on the WIT were reflected in the number of older adults unable to complete CWTs and a decrease in gait velocity. For all tasks, decrements in walking speed with increasing age were significantly larger at aged 65 and older. Performance on CWTs was highly variable and could not be explained by usual gait speed measured under low-challenge conditions alone. CONCLUSION: CWTs may provide important insight into mobility function, particularly in persons with normal or near-normal usual gait speed. Further research is needed to elucidate the specific physiological mechanisms that contribute to declining performance on CWT with increasing age.

Adult↗

PubMed2006

Effects of the diabetes linked TCF7L2 polymorphism in a representative older population.

BACKGROUND: A polymorphism in the transcription factor 7-like 2 (TCF7L2) gene has been found to be associated with type 2 diabetes in case-control studies. We aimed to estimate associations of the marker rs7903146 (C/T) polymorphism with fasting glucose, lipids, diabetes prevalence and complications in an older general population. METHODS: In total, 944 subjects aged > or = 65 years from the population representative InCHIANTI study were enrolled in this study. Those with fasting blood glucose of > or = 7 mmol/l or physician diagnosis were considered diabetic. Cut-off points for impaired fasting glucose (IFG) were > or = 5.6 mmol/l to < 7 mmol/l. RESULTS: In the general population sample, minor (T) allele carriers of rs7903146 had higher fasting blood glucose (FBG) (p = 0.028) but lower fasting insulin (p = 0.030) and HOMA2b scores (p = 0.001), suggesting poorer beta-cell function. T allele carriers also had smaller waist circumference (p = 0.009), lower triglyceride levels (p = 0.006), and higher high-density lipoprotein cholesterol (p = 0.008). The prevalence of diabetes or IFG was 32.4% in TT carriers and 23.3% in CC carriers; adjusted OR = 1.67 (95% confidence interval 1.05 to 2.65, p = 0.031). Within the diabetic and IFG groups, fewer T allele carriers had metabolic syndrome features (p = 0.047) or had experienced a myocardial infarction (p = 0.037). Conversely, T allele carriers with diabetes had poorer renal function (reduced 24-hour creatinine clearance, p = 0.013), and possibly more retinopathy (p = 0.067). Physician-diagnosed dementia was more common in the T carriers (in diabetes p = 0.05, with IFG p = 0.024). CONCLUSION: The TCF7L2 rs7903146 polymorphism is associated with lower insulin levels, smaller waist circumference, and lower risk lipid profiles in the general elderly population. Patients with diabetes who are carriers of the minor allele are less likely to have metabolic-syndrome features, but may experience more microvascular complications, although the number of cases was small. If replicated, these findings may have implications for developing treatment approaches tailored by genotype.

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PubMed2006

Low micronutrient levels as a predictor of incident disability in older women.

BACKGROUND: The role of nutritional status in the disablement process is still unclear. The objective of this study was to assess whether low concentrations of nutrients predict the development and course of disability. METHODS: Longitudinal study including community-dwelling women 65 years or older enrolled in the Women's Health and Aging Study I. In total, 643 women were assessed prospectively at 6-month intervals from 1992 to 1995. RESULTS: Incidence rates of disability in activities of daily living (ADLs) during 3 years of follow-up. Incidence rates in the lowest quartile of each selected nutrient were compared with those in the upper quartiles. The hazard ratios were estimated from Cox models adjusted for potential confounders. Women in the lowest quartile of serum concentrations of vitamin B(6) (hazard ratio [HR], 1.31; 95% confidence interval [CI], 1.03-1.67), vitamin B(12) (HR, 1.40; 95% CI, 1.12-1.74), and selenium (HR, 1.38; 95% CI, 1.12-1.71) had significantly higher risk of disability in ADLs during 3 years of follow-up compared with women in the upper 3 quartiles. CONCLUSIONS: Low serum concentrations of vitamins B(6) and B(12) and selenium predict subsequent disability in ADLs in older women living in the community. Nutritional status is one of the key factors to be considered in the development of strategies aimed at preventing or delaying the disablement process.

Aged↗

PubMed2006

The pathway from musculoskeletal pain to mobility difficulty in older disabled women.

Little is known about the pathway from musculoskeletal pain to mobility difficulty among older persons. We examined potential physical and psychological mediators of the pain-disability relationship in the Women's Health and Aging Study (WHAS), a cohort of women aged 65 who had at least mild disability at baseline. Pain was classified according to location and severity (widespread pain; lower extremity pain; other pain; none or mild pain in only one site). Among women without a lot of difficulty in stair climbing (n=676) or walking (n=510) at baseline, those who reported widespread pain were more likely than those with none or mild pain to develop a lot of difficulty with mobility during the 3 year follow-up. The likelihood for mobility difficulty was unchanged after adjusting for physical impairments and symptoms of depression and anxiety (walking aOR=1.85, 95%CI, 1.08-3.17; stair climbing, aOR=2.68, 95%CI, 1.56-4.62). Lower extremity pain was associated with increased likelihood for difficulty with climbing stairs but not with walking. However, this association was attenuated after adjusting for physical impairments and psychological symptoms (aOR=1.66, 95%CI, 0.99-2.77). Pain was not associated with increased risk for becoming unable to walk or climb stairs. The findings suggest that pain is a unique domain as a cause of disablement, independent of the usual pathway to disability via physical impairments. Research is needed to better understand the development of pain-related disability in order to determine optimum approaches to prevent and treat mobility disability in older persons with persistent pain.

Activities of Daily Living↗

PubMed2006

Lower extremity nerve function in patients with lower extremity ischemia.

BACKGROUND: We determined whether lower extremity ischemia, as measured by the ankle brachial index (ABI), is associated with impaired lower extremity nerve function. METHODS: Participants included 478 persons with peripheral arterial disease (PAD) identified from noninvasive vascular laboratories and 292 persons without PAD identified from a general medicine practice and noninvasive vascular laboratories. Peripheral arterial disease was defined as an ABI lower than 0.90 (mild PAD: ABI, 0.70 to <0.90; moderate PAD: ABI, 0.50 to <0.70; and severe PAD: ABI, <0.50). The ABI and electrophysiologic measures of the peroneal, sural, and ulnar nerves were obtained. RESULTS: Among 546 participants without diabetes, PAD participants had significantly impaired peripheral nerve function in the upper and lower extremities compared with non-PAD participants. After adjusting for age, sex, race, smoking, height, body mass index, recruitment source, alcohol use, disk disease, spinal stenosis, cardiac disease, and cerebrovascular disease, these associations were not statistically significant. After adjusting for confounders among nondiabetic participants, those with severe PAD (ABI, <0.50) had poorer peroneal nerve conduction velocity (NCV) compared with participants without PAD (42.6 vs 44.8 m/s; P = .003) and poorer peroneal NCV compared with participants with mild PAD (42.6 vs 45.0 m/s; P = .001) or moderate PAD (42.6 vs 44.1 m/s; P = .03). Among 224 participants with diabetes, after adjusting for confounders, PAD was associated with poorer peroneal NCV (40.8 vs 43.5 m/s; P = .01), sural nerve amplitude (3.1 vs 4.8 muV; P = .045), and ulnar NCV (47.6 vs 50.2 m/s; P = .03) compared with those without PAD. CONCLUSIONS: Our findings suggest that leg ischemia impairs peroneal nerve function. This association is less strong in patients with diabetes, perhaps because of the overriding influence of diabetes on peripheral nerve function. Clinicians should consider screening for PAD in patients with idiopathic peroneal nerve dysfunction. Peripheral arterial disease-associated nerve dysfunction may contribute to PAD-associated functional impairment.

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PubMed2006

Association of hormonal dysregulation with metabolic syndrome in older women: data from the InCHIANTI study.

Metabolic syndrome (MetS) is a strong risk factor for type 2 diabetes and cardiovascular disease. Conditions associated with hyperandrogenism are often associated with glucose intolerance and other features of MetS in young women. As the prevalence of MetS increases with age and is probably multifactorial, it is reasonable to hypothesize that age-related changes in androgens and other hormones might contribute to the development of MetS in older persons. However, this hypothesis has never been tested in older women. We hypothesized that high levels of testosterone, dehydroepiandrosterone sulfate (DHEA-S), and cortisol and low levels of sex hormone-binding globulin (SHBG) and IGF-I would be associated with MetS in a representative cohort of older Italian women independently of confounders (including inflammatory markers). After exclusion of participants on hormone replacement therapy and those with a history of bilateral oophorectomy, 512 women (>/=65 yr) had complete data on testosterone, cortisol, DHEA-S, SHBG, fasting insulin, total and free IGF-I, IL-6, and C-reactive protein (CRP). MetS was defined according to ATP-III criteria. Insulin resistance was calculated according to HOMA. MetS was found in 145 women (28.3%). Participants with vs. those without MetS had higher age-adjusted levels of bioavailable testosterone (P < 0.001), IL-6 (P < 0.001), CRP (P < 0.001), and HOMA (P < 0.001) and lower levels of SHBG (P < 0.001). After adjustment for potential confounders, participants with decreased SHBG had an increased risk of MetS (P < 0.0001) vs. those with low SHBG. In a further model including all hormones and confounders, log SHBG was the only independent factor associated with MetS (OR: 0.44, 95% CI 0.21-0.91, P = 0.027). In older women, SHBG is negatively associated with MetS independently of confounders, including inflammatory markers and insulin resistance. Further studies are needed to support the notion that raising SHBG is a potential therapeutic target for prevention and treatment of MetS.

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PubMed2006

Gradient of disability across the socioeconomic spectrum in the United States.

BACKGROUND: Although the relationship between extreme poverty and poor health among older adults has long been recognized, less attention has been devoted to investigating whether a gradient in disability exists in the United States among persons with middle-class and upper-class incomes. We attempted to determine whether a gradient in functional limitation exists across the full spectrum of income among persons 55 years of age or older. METHODS: We obtained data from the Census 2000 Supplementary Survey, which used the methods and questionnaire of the American Community Survey, a nationally representative survey of 890,698 households with a response rate of 95 percent. Our sample included 149,000 men and 186,675 women who were at least 55 years of age, of whom 32,680 men and 48,111 women reported having a functional limitation (a long-lasting condition that substantially limited one or more basic physical activities, such as climbing stairs or lifting). RESULTS: A social-class gradient was observed for both men and women between the ages of 55 and 84, a gradient that held true even at the upper rungs of the socioeconomic ladder. For example, in comparison to persons between the ages of 55 and 64 who lived at 700 percent of the poverty line or above, persons of the same age but below the poverty line had six times the odds of reporting a functional limitation. With increasing income, the odds ratio declined. A significant gradient was present up to, but not beyond, the age of 85 years. CONCLUSIONS: Our findings suggest that functional limitation in Americans between the ages of 55 and 84 years is inversely related to social class across the full spectrum of the socioeconomic gradient.

Activities of Daily Living↗

PubMed2006

Midlife physical activity and mobility in older age: The InCHIANTI study.

BACKGROUND: Among older adults, loss of mobility represents a critical stage in the disablement process, whereby the risk for disability is significantly increased. Physical activity is a modifiable risk factor that is associated with reduced risk of losing mobility in older adulthood; however, few studies have examined physical activity performed earlier in life in relation to mobility later in life. METHODS: Data from a population-based study of 1155 adults aged 65 years and older living in the Chianti region of Italy in 1998-2000 were analyzed in 2005 and 2006. Participants retrospectively recalled their physical activity levels in midlife and underwent mobility testing and medical examination. Two objective mobility outcomes were examined as a function of past physical activity: the Short Physical Performance Battery (SPPB) and the ability to walk 400 meters. RESULTS: Older Italian adults (mean age 74.8, standard deviation 7.3) who engaged in higher levels of physical activity in midlife were significantly more likely to perform better on the SPPB than individuals who were less physically active in midlife. In addition, failure to complete the 400-meter walk test was significantly less likely among physically active men (Level II) (odds ratio [OR] = 0.37, 95% confidence interval [CI] = 0.15-0.93) and very active men (Level III) (OR = 0.23, 95% CI = 0.09-0.63) when compared to men who were less active (Level I) in the past (p for trend, 0.008). These associations remained after adjustment for demographic factors, medical conditions, and physiologic impairments. CONCLUSIONS: Older adults who reported higher levels of physical activity in midlife had better mobility in old age than less physically active ones.

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PubMed2006

Low testosterone levels and the risk of anemia in older men and women.

BACKGROUND: Anemia is a frequent feature of male hypogonadism and anti-androgenic treatment. We hypothesized that the presence of low testosterone levels in older persons is a risk factor for anemia. METHODS: Testosterone and hemoglobin levels were measured in a representative sample of 905 persons 65 years or older without cancer, renal insufficiency, or anti-androgenic treatments. Hemoglobin levels were reassessed after 3 years. RESULTS: At baseline, 31 men and 57 women had anemia. Adjusting for confounders, we found that total and bioavailable testosterone levels were associated with hemoglobin levels in women (P = .001 and P = .02, respectively) and in men (P<.001 and P = .03, respectively). Men and women in the lowest quartile of total and bioavailable testosterone were more likely than those in the highest to have anemia (men, 14/99 vs 3/100; odds ratio [OR], 5.4; 95% confidence interval [CI], 1.4-21.8 for total and 16/99 vs 1/99; OR, 13.1; 95% CI, 1.5-116.9 for bioavailable testosterone; women, 21/129 vs 12/127; OR, 2.1; 95% CI, 0.9-5.0 for total and 24/127 vs 6/127; OR, 3.4; 95% CI, 1.2-9.4 for bioavailable testosterone). Among nonanemic participants and independent of confounders, men and women with low vs normal total and bioavailable testosterone levels had a significantly higher risk of developing anemia at 3-year follow-up (21/167 vs 28/444; relative risk, 2.1; 95% CI, 1.1-4.1 for total and 26/143 vs 23/468; relative risk, 3.9; 95% CI, 1.9-7.8 for bioavailable testosterone). CONCLUSION: Older men and women with low testosterone levels have a higher risk of anemia.

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PubMed2006

Physical activity during daily life and mortality in patients with peripheral arterial disease.

BACKGROUND: We determined whether patients with lower-extremity peripheral arterial disease (PAD) who are more physically active during daily life have lower mortality rates than PAD patients who are less active. METHODS AND RESULTS: Participants were 460 men and women with PAD (mean age 71.9+/-8.4 years) followed up for 57 months (interquartile range 36.6 to 61.9 months). At baseline, participants were interviewed about their physical activity. Vertical accelerometers measured physical activity continuously over 7 days in 225 participants. Analyses were adjusted for age, sex, race, body mass index, hypertension, smoking, comorbidities, total cholesterol, HDL cholesterol, leg symptoms, and ankle-brachial index. At 57-month follow-up, 134 participants (29%) had died, including 75 participants (33%) who wore accelerometers. Higher baseline physical activity levels measured by vertical accelerometer were associated with lower all-cause mortality (P(trend)=0.003). Relative to PAD participants in the highest quartile of accelerometer-measured physical activity, those in the lowest quartile had higher total mortality (hazard ratio 3.48, 95% confidence interval 1.23 to 9.87, P=0.019). Similar results were observed for the combined outcome of cardiovascular events or cardiovascular mortality (P(trend)=0.005). Higher numbers of stair flights climbed during 1 week were associated with lower total mortality (P(trend)=0.035). CONCLUSIONS: PAD patients with higher physical activity during daily life have reduced mortality and cardiovascular events compared with PAD patients with the lowest physical activity, independent of confounders. Further study is needed to determine whether interventions that increase physical activity during daily life are associated with improved survival in patients with PAD.

Activities of Daily Living↗

PubMed2006

Self-rated health showed a graded association with frequently used biomarkers in a large population sample.

BACKGROUND AND OBJECTIVES: Self-rated health is a widely used measure of health status, but its biologic foundations are poorly understood. We investigated the association of frequently used biomarkers with self-rated health, and the role of these biomarkers in the association of self-rated health with mortality. METHODS: The relation of self-rated health to blood levels of albumin, white blood cell count, hemoglobin, HDL cholesterol, and creatinine was examined in a population-based sample of 4,065 men and women aged 71 years or older. A Cox proportional hazards model was used to determine the association of self-rated health with mortality during 4.9 years. Sociodemographic factors, diagnosed chronic conditions, and activities of daily living disability were controlled for in these analyses. RESULTS: All the biomarkers showed a graded relationship with self-rated health. After adjusting for other indicators, hemoglobin and white cell count were significantly associated with fair or poor self-rated health. When biomarkers and other indicators were adjusted for, self-rated health still was a significant predictor of mortality. CONCLUSION: Self-rated health has a biologic basis, and it can be a sensitive barometer of physiologic states. Self-rated health is likely to predict mortality because it covers the spectrum of health conditions better than the variables measured in the study.

Activities of Daily Living↗

PubMed2006

Statin use and functional decline in patients with and without peripheral arterial disease.

OBJECTIVES: We determined whether statin use (vs. non-use) is associated with less annual decline in lower-extremity functioning in patients with and without lower-extremity peripheral arterial disease (PAD) over three-year follow-up. BACKGROUND: It is unclear whether statin use is associated with less functional decline in patients with PAD. METHODS: Participants included 332 men and women with an ankle brachial index (ABI) <0.90 and 212 with ABI 0.90 to 1.50. Functional outcomes included 6-min walk distance and usual and rapid-pace 4-m walking velocity. A summary performance score combined performance in walking speed, standing balance, and time for five repeated chair rises into an ordinal score ranging from 0 to 12 (12 = best). RESULTS: Adjusting for age, race, gender, comorbidities, education, health insurance, total cholesterol/high-density lipoprotein level, body mass index, pack-years of smoking, leg symptoms, immediately previous year functioning, statin use/non-use, ABI, and change in ABI, the PAD participants using statins had less annual decline in usual-pace walking velocity (0.002 vs. -0.024 m/s/year, p = 0.013), rapid-pace walking velocity (-0.006 vs. -0.042 m/s/year, p = 0.006), 6-min walk performance (-34.5 vs. -57.9 feet/year, p = 0.088), and the summary performance score (-0.152 vs. -0.376, p = 0.067) compared with non-users. These associations were attenuated slightly by additional adjustment for high-sensitivity C-reactive protein levels. Among non-PAD participants, there were no significant associations between statin use and functional decline. CONCLUSIONS: The PAD patients on statins have less annual decline in lower-extremity performance than PAD patients who are not taking statins.

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PubMed2006

Physical performance in peripheral arterial disease: a slower rate of decline in patients who walk more.

BACKGROUND: Exercise rehabilitation programs increase treadmill walking performance in patients with peripheral arterial disease (PAD) and intermittent claudication. However, it is unknown whether patients with PAD who walk for exercise regularly have less functional decline than those with less walking activity. OBJECTIVE: To determine whether patients with PAD who report that they walk for exercise 3 or more times per week have less annual functional decline than those who walk for exercise less frequently. DESIGN: Prospective cohort study with a median follow-up of 36 months (interquartile range, 24 to 36 months). SETTING: Academic medical center. PARTICIPANTS: 417 men and women with PAD. MEASUREMENTS: Participants were classified at baseline and annually according to the number of times they reportedly walked for exercise each week. Functional assessments (6-minute walk distance, 4-meter walking speed, summary performance score) were measured at baseline and annually. Results were adjusted for age, sex, ethnicity, comorbid conditions, body mass index, ankle-brachial index, education, leg symptoms, cigarette use, geriatric depression score, previous year's level of functioning, and patterns of missing data. RESULTS: Compared with those who exercised less frequently, patients who walked for exercise 3 or more times per week had a significantly smaller average annual decline in 6-minute walking distance (-48.0 feet per year compared with -56.6 feet per year for those who walked 1 to 2 times per week and -79.4 feet per year for nonexercisers; P for trend = 0.037). Patients who walked for exercise at least 3 times per week experienced a smaller average annual decline in the usual-paced 4-meter walking velocity (-0.014 m/s per year compared with -0.022 m/s per year for those who walked 1 to 2 times per week and -0.045 m/s per year for nonexercisers; P = 0.005). Similar findings were observed for the fast-paced 4-meter walk. The subset of asymptomatic patients who walked for exercise 3 or more times per week had annual declines in 6-minute walking performance (P = 0.107), normal-paced walking velocity (P = 0.065), and the summary performance score (P = 0.115); however, these declines were smaller than those observed in asymptomatic participants who walked fewer than 3 times per week. LIMITATIONS: Because this was an observational study, associations reported here cannot be construed as causal relationships. Sample sizes for subgroup analyses were small, which limited statistical power. CONCLUSION: Among patients with PAD, self-directed walking exercise performed at least 3 times weekly is associated with significantly less functional decline during the subsequent year. Similar trends were observed in the subset of asymptomatic patients with PAD. These findings may be particularly important for the numerous patients with PAD who do not have access to supervised walking exercise programs.

Disability Evaluation↗

PubMed2006

Comparison of exercise models in an elderly population.

BACKGROUND AND AIMS: Two different models of exercise behavior in an older population have been previously published (Schuster et al., 1995 and Resnick et al., 2000). We aimed to validate the models with data from a different sample, and to examine whether any of these models explained a greater proportion of the variance in exercise behavior in this population. METHODS: Participants were 324 community- dwelling persons aged 74-85 years who completed a mailed questionnaire. The questionnaire included questions about demographics, current exercise habits, health, activities of daily living, depressed affect, living arrangement, attitudes about exercise, self-efficacy, barriers to exercise, and enjoyment of exercise. RESULTS: While our data explained some of the variance of the two previously published models of exercise behavior, the percentage of variance explained was less impressive than that reported by those authors. A path analysis of demographic and psychological constructs, which have been used in both models, demonstrated that physical health, mental health, gender, and past enjoyment of exercise affect self-efficacy, attitudes/outcome expectancy, and reported barriers to exercise. These psychological constructs in turn affect exercise habits. CONCLUSIONS: The relatively low percentage of variance explained by the models may imply that other factors contribute to exercise behavior in older adults, that the constructs are very sensitive to measurement differences, or that these factors are not as important as previously thought. Our results are consistent with the models of both Schuster et al. and Resnick et al., but suggest that a combined model may better represent the data. Future investigations of exercise behavior in older persons should examine this possibility.

Activities of Daily Living↗

PubMed2006

A randomized, controlled trial of disability prevention in frail older patients screened in primary care: the FRASI study. Design and baseline evaluation.

BACKGROUND AND AIMS: We describe the enrollment and intervention phases of FRASI (FRAilty, Screening and Intervention), a randomized controlled trial aimed at preventing ADL disability in frail older persons screened in primary care. METHODS: Patients, 70-85 years old, non-disabled and noncognitively impaired, were screened for frailty (score < or = 9 on the Short Physical Performance Battery, SPPB) during primary care visits. Of 447 eligible persons, 410 came to the study clinic and 251 were randomized into treatment (n=126) and control groups (n=125). The active group received an intensive medical intervention, and sixteen 90-minute supervised exercise sessions over 8 weeks. The primary outcome was time to ADL disability onset or death in the 12-month period after study enrollment. RESULTS: The two study arms were similar for demographics, cognitive function, physical function and health status. Compared with a population-based sample selected according to FRASI inclusion criteria except SPPB score, FRASI participants had significantly worse health and functional status. Restricting the comparison to persons with SPPB < or = 9, all differences disappeared. The 99 participants (78.6% of 126) who completed the intervention participated in a mean of 15.3+/-1.6 exercise sessions. CONCLUSIONS: Screening in primary care for non-disabled, older persons with SPPB < or = 9 yields individuals with substantial morbidity, impairments and functional limitations that can be successfully involved in an intensive medical and exercise intervention. Whether such an intervention effectively prevents new disability remains to be confirmed.

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PubMed2006

Concordance and discordance between two measures of lower extremity function: 400 meter self-paced walk and SPPB.

BACKGROUND AND AIMS: The purpose of the study was to assess the concurrent validity of the 400 meter self-paced walk test (400-m W) against the commonly used short physical performance battery (SPPB). A secondary purpose was to determine whether the 400-m W could better discriminate physical performance among high functioning older adults by examining the distribution of 400-m W scores. METHODS: 101 men and women (80.8+/-0.4 years) were recruited to participate in the study. The 400-mW and SPPB assessed lower extremity function. Lower extremity muscle strength, power, and contraction velocity was assessed using bilateral leg press (LP). Health history was obtained with questionnaire. RESULTS: 400-m W demonstrated moderate correlations with SPPB (Pearson r=0.74; p< 0.001). In 36 high functioning individuals (SPPB score= 10, 11, 12), participants above the median 400-m W performance time (n=20) had more medical conditions (2.8+/-0.4 vs 1.7+/-0.3; p=0.038), more reported falls (0.80+/-0.2 vs 0.19+/-0.1; p=0.016), more medications (3.7+/-0.4 vs 1.8+/-0.4; p=0.001), had lower LP power at 70% of the one repetition maximum (1RM) (336+/-45 W vs 663+/-78 W; p=0.001) and 40% 1RM (329+/-43 W vs 580+/-75 W; p=0.005), and had slower LP contraction velocity at 40% 1RM (77+/-5.5 m/s vs 112+/-8.4 m/s; p=0.001) compared with those below the median (n=16). CONCLUSIONS: A substantial number of apparently well functioning older adults demonstrated some limitations in the ability to walk 400 meters. Use of the 400-m W may be justified to obtain information to better discriminate among high functioning elderly.

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PubMed2006

Obesity, weight change, and functional decline in peripheral arterial disease.

BACKGROUND: Our objectives were to determine whether obesity is associated with a greater functional decline compared with the ideal body mass index (BMI) among persons with peripheral arterial disease (PAD) and to determine the associations between weight gain and loss and functional declines in PAD. We hypothesized that baseline obesity and weight gain during follow-up would each be associated with functional declines in persons with PAD. METHODS: The design was a prospective cohort study. The subjects were 389 men and women with PAD (mean ankle-brachial index, 0.65 +/- 0.14) who were followed up prospectively for a median of 48 months. The main outcome measures were functional assessments (6-minute walk, usual- and rapid-paced 4-m walking speed, and summary performance score). Weight and height were measured at baseline and annually. Results were adjusted for age, sex, race, comorbidities, ankle-brachial index, education, leg symptoms, exercise status, depressive symptoms, pack-years of cigarette smoking, prior-year functioning, and patterns of missing data. RESULTS: Compared with those with a baseline BMI between 20 and 25 kg/m2, PAD participants with baseline BMI greater than 30 kg/m2 had a significantly greater average annual decline in 6-minute walk performance (-13.1 vs -26.5 m/y; P = .004), usual-paced 4-m walking velocity (-0.028 vs -0.055 m/s per year; P = .024), and fast-paced 4-m walking velocity (-0.053 vs -0.086 m/s per year; P = .012). Persons with weight gain between 5 and 10 pounds after baseline who walked for exercise regularly had significantly less decline in the 6-minute walk than persons without significant weight change who did not walk for exercise (P = .04). CONCLUSIONS: Obesity is associated with functional decline in persons with PAD. Walking exercise may protect against functional decline in PAD persons with modest weight gain.

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PubMed2006

Association of executive function and performance of dual-task physical tests among older adults: analyses from the InChianti study.

BACKGROUND: previous studies have reported an association between cognitive function and physical performance, particularly among older adults. OBJECTIVE: to examine the association between executive function and performance difference on complex versus usual walking tasks in a sample of non-demented older adults. DESIGN: population-based epidemiological study of older people residing in the Chianti area (Tuscany, Italy). PARTICIPANTS: 737 community-dwelling individuals aged 65 years and older. METHODS: gait speed (m/s) was measured during the performance of complex walking tasks (walking/talking, walking/picking-up an object, walking/carrying a large package, walking over obstacles, walking with a weighted vest) and reference walking tasks (7 m usual pace, 7 m fast pace and 60 m fast pace). Executive function was assessed using the Trail Making Test (TMT). Other measures included Mini-Mental State Examination (MMSE), sociodemographic characteristics and selected physiological impairments. RESULTS: gait speed for the selected reference and complex walk tasks was consistently lower among participants with poor executive function. Per cent decline in gait speed compared with the reference task differed by executive function for certain tasks (e.g. walking/obstacles: 30 versus 24% decline in low versus high executive function respectively, P = 0.0006) but not for others. CONCLUSIONS: poor executive function is associated with measures of gait, including specific challenges. Overall, the results showed that the cost associated with the addition of a challenge to the basic walking task differs by executive function and the nature of the task. Further research is needed to determine whether improvement in executive function abilities translates to better performance on selected complex walking tasks.

Activities of Daily Living↗