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PubMed2005

Muscle mass, muscle strength, and muscle fat infiltration as predictors of incident mobility limitations in well-functioning older persons.

BACKGROUND: Lower muscle mass has been correlated with poor physical function; however, no studies have examined this relationship prospectively. This study aims to investigate whether low muscle mass, low muscle strength, and greater fat infiltration into the muscle predict incident mobility limitation. METHODS: Our study cohort included 3075 well-functioning black and white men and women aged 70-79 years participating in the Health, Aging, and Body Composition study. Participants were followed for 2.5 years. Muscle cross-sectional area and muscle tissue attenuation (a measure of fat infiltration) were measured by computed tomography at the mid-thigh, and knee extensor strength by using a KinCom dynamometer. Incident mobility limitation was defined as two consecutive self-reports of any difficulty walking one-quarter mile or climbing 10 steps. RESULTS: Mobility limitations were developed by 22.3% of the men and by 31.8% of the women. Cox's proportional hazards models, adjusting for demographic, lifestyle, and health factors, showed a hazard ratio of 1.90 [95% confidence interval (CI), 1.27-2.84] in men and 1.68 (95% CI, 1.23-2.31) in women for the lowest compared to the highest quartile of muscle area (p <.01 for trend). Results for muscle strength were 2.02 (95% CI, 1.39-2.94) and 1.91 (95% CI, 1.41-2.58), p <.001 trend, and for muscle attenuation were 1.91 (95% CI, 1.31-2.83) and 1.68 (95% CI, 1.20-2.35), p <.01 for trend. When included in one model, only muscle attenuation and muscle strength independently predicted mobility limitation (p < .05). Among men and women, associations were similar for blacks and whites. CONCLUSION: Lower muscle mass (smaller cross-sectional thigh muscle area), greater fat infiltration into the muscle, and lower knee extensor muscle strength are associated with increased risk of mobility loss in older men and women. The association between low muscle mass and functional decline seems to be a function of underlying muscle strength.

Aged↗
PubMed2006

Self-reported and test-based mobility limitations in a representative sample of Finns aged 30+.

AIMS: The object of the present study was to acquire a comprehensive and accurate picture of mobility limitations in the Finnish adult population. METHODS: A nationally representative sample of 8,028 persons aged 30+ with high participation was interviewed and examined in the Health 2000 Survey conducted in 2000-01. Mobility limitations were measured by self-reports and performance tests. RESULTS: Perceived running difficulties were already common among persons in middle age, while difficulties in moving about indoors were frequent only among persons aged 75+. A third of women and a fifth of men aged 55+ could not reach a walking speed of 1.2 m/s. Working-aged women were more limited than men only in physically demanding tasks, but in the elderly the gender difference was evident in most mobility tasks. A substantial disagreement was found between the self-reported and test-based indicators in stair climbing. Supplementary data collection, carried out to increase participation in the health examination, as well as inclusion of institutionalized persons, provided a more complete estimate of the prevalence of mobility limitations among the elderly. CONCLUSIONS: Both self-reported and performance-based indicators are needed to achieve a comprehensive view of disability and its variation between population groups. Exclusion of institutionalized persons and low participation lead to underestimation of the occurrence of limitations. The number of persons suffering from mobility problems will increase with ageing of the population, which accentuates the importance of early intervention to maintain functional ability, especially in women.

Activities of Daily Living↗
PubMed2002

The relationship between leg power and physical performance in mobility-limited older people.

OBJECTIVES: The purpose of this study was to assess the influence of leg power and leg strength on the physical performance of community-dwelling mobility-limited older people. DESIGN: Cross-sectional analysis of baseline data from a 12-week randomized controlled exercise-intervention study. SETTING: Exercise laboratory within the Department of Health Science of an urban university. PARTICIPANTS: Forty-five community-dwelling mobility-limited people (34 women, 11 men), aged 65 to 83. MEASUREMENTS: Health status, depression, cognition, physical activity, and falls efficacy; physiological measures of lower extremity strength and power; and measures of physical performance. RESULTS: Through bivariate analyses, leg power was significantly associated with physical performance as measured by stair-climb time, chair-stand time, tandem gait, habitual gait, maximal gait, and the short physical performance battery describing between 12% and 45% of the variance (R2). Although leg power and leg strength were greatly correlated (r = .89) in a comparison of bivariate analyses of strength or power with physical performance, leg power modeled up to 8% more of the variance for five of six physical performance measures. Despite limitations in sample size, it appeared that, through quadratic modeling,the influence of leg power on physical performance was curvilinear. Using separate multivariate analyses, partial R2 values for leg power and leg strength were compared, demonstrating that leg power accounted for 2% to 8% more of the variance with all measures of physical performance. CONCLUSION: Leg power is an important factor influencing the physical performance of mobility-limited older people. Although related to strength, it is a separate attribute that may exert a greater influence on physical performance. These findings have important implications for clinicians practicing geriatric rehabilitation.

Age Factors↗
PubMed2000

Factors that modify the association between knee pain and mobility limitation in older women: the Women's Health and Aging Study.

OBJECTIVE: To investigate the influence of pain severity, knee extensor muscle weakness, obesity, depression, and activity on the association between recent knee pain and limitation of usual and fast paced walking, and ability to rise from a chair. METHODS: A cross sectional analysis of 769 older women (mean age 77.8, range 65-101) with physical disability, but no severe cognitive impairment. Severity of knee pain in the past month was classified as none, moderate, or severe. Mobility was measured using timed performance tests. RESULTS: The prevalence of recent knee pain was 53% (408/769). One third of the women with pain reported it to be severe. In general, knee pain was only significantly associated with limited mobility if severe. Obesity, activity and, to a lesser extent, depression intensified the effects of pain. Knee extensor weakness did not. Obesity was a distinctive risk factor in that it substantially increased the risk of mobility limitation, but only in women with pain. In women who had severe pain, activity (walking more than three city blocks in the past week) increased the risk of walking disability more than inactivity. Depression had a minor, but statistically significant effect on walking ability, but not the ability to rise from a chair. CONCLUSION: In older women with recent knee pain, a high pain severity score, obesity, and activity are important factors that increase the risk of mobility limitation.

Aged↗
PubMed2005

Validation of the Reintegration to Normal Living Index in a population of community-dwelling people with mobility limitations.

OBJECTIVE: To validate the Reintegration to Normal Living Index (RNLI) in a population of community-dwelling adults with mobility limitations. DESIGN: Cross-sectional survey. SETTING: Community. PARTICIPANTS: Six hundred four people between the ages of 18 and 80 years who had a mobility limitation, lived in the community, and had been discharged from rehabilitation for at least 1 year. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The RNLI. RESULTS: The RNLI is a reliable measure of community reintegration. A 2-factor structure emerged from a principal components analysis that indicates there are 2 subscales of the RNLI in a population with mobility impairments. CONCLUSIONS: The RNLI is a reliable and valid measure for studies of community integration among people living with long-term consequences of a chronic health condition.

Adolescent↗
PubMedDate not supplied

[Limited mobility of the joints: A complication of diabetes mellitus in children and adolescents].

The incidence of a specific complication, limited mobility of the joints (mainly of interphalangeal joints of the hand), was estimated in 108 patients aged 6 to 22 with insulin-dependent diabetes of 5 and more years duration. It was found to be high: 44%. This complication more frequently develops in cases of poor metabolic control and longer disease duration. Limited mobility of the joints in children and adolescents with insulin-dependent diabetes permits predict in them with a 50% probability early manifestations of retinopathy and nephropathy. A classification of this complication by three degrees is offered.

Adolescent↗
PubMed2002

Layer-by-layer epitaxy in limited mobility nonequilibrium models of surface growth.

We study, using noise-reduction techniques, layer-by-layer epitaxial growth in limited mobility solid-on-solid nonequilibrium surface growth models, which have been introduced in the context of kinetic surface roughening in ideal molecular beam epitaxy. Multiple hit noise reduction and long surface diffusion length lead to qualitatively similar layer-by-layer epitaxy in (1+1)- and (2+1)-dimensional limited mobility growth simulations. We discuss the dynamic scaling characteristics connecting the transient layer-by-layer growth regime with the asymptotic kinetically rough growth regime.

Journal Article↗
PubMed2005

Sequencing sit-to-stand and upright posture for mobility limitation assessment: determination of the timing of the task phases from force platform data.

The identification of quantitative tools to assess an individual's mobility limitation is a complex and challenging task. Several motor tasks have been designated as potential indicators of mobility limitation. In this study, a multiple motor task obtained by sequencing sit-to-stand and upright posture was used. Algorithms based on data obtained exclusively from a single force platform were developed to detect the timing of the motor task phases (sit-to-stand, preparation to the upright posture and upright posture). To test these algorithms, an experimental protocol inducing predictable changes in the acquired signals was designed. Twenty-two young, able-bodied subjects performed the task in four different conditions: self-selected natural and high speed with feet kept together, and self-selected natural and high speed with feet pelvis-width apart. The proposed algorithms effectively detected the timing of the task phases, the duration of which was sensitive to the four different experimental conditions. As expected, the duration of the sit-to-stand was sensitive to the speed of the task and not to the foot position, while the duration of the preparation to the upright posture was sensitive to foot position but not to speed. In addition to providing a simple and effective description of the execution of the motor task, the correct timing of the studied multiple task could facilitate the accurate determination of variables descriptive of the single isolated phases, allowing for a more thorough description of the motor task and therefore could contribute to the development of effective quantitative functional evaluation tests.

Adult↗
PubMed2002

Weighted stair climbing in mobility-limited older people: a pilot study.

OBJECTIVES: To evaluate weighted stair climbing exercise (SCE) as a means of increasing lower extremity muscle power in mobility-limited older people. DESIGN: Single-blinded, randomized controlled pilot study. SETTING: Human physiology laboratory of a metropolitan university. PARTICIPANTS: Forty-five community-dwelling people aged 65 and older who had baseline mobility limitations manifested by scores of 11 or lower on the Short Physical Performance Battery (SPPB). INTERVENTIONS: Subjects were randomized into one of two 12-week exercise programs. The intervention group (SCE) (n = 23) ascended and descended stairs, at a set pace, while wearing a weighted vest. The control group (WALK) (n = 22) participated in a standardized walking program. MEASUREMENTS: Primary and secondary outcomes included measures of muscle power and strength, submaximal aerobic capacity, and physical performance. RESULTS: SCE produced 17% improvement in double leg press peak power in comparison with WALK (P =.013) and significant improvement in stair climbing power from baseline (12%). Improvement in submaximal aerobic performance was equivalent for both groups. Although not statistically significant, effect size estimates suggest that SCE can potentially influence knee extension power and strength. Stair climb time was improved in both groups, whereas SCE produced significant improvements from baseline SPPB score in a subcohort of participants. CONCLUSIONS: These findings suggest that SCE maybe a useful component of a home exercise program designed to enhance lower extremity muscle power, aerobic capacity, and functional performance. Further investigation is needed involving larger sample sizes and direct comparisons with other forms of resistance training.

Aged↗
PubMed2004

[Shoulder pain and limited mobility in the course of algodystrophy of the hand].

UNLABELLED: Algodystrophy typically affects distal parts of upper extremity: the hand and the wrist. Some patients, however, complain of pain and limited mobility in shoulder joint and these symptoms are not related to predisposed injury but appear secondary in the course of the condition. Cause and pathogenesis of this disorder in unknown. The objectives of the study were to investigate incidence of shoulder complains in the patients suffered of algodystrophy of the hand and to evaluate results of the treatment with local steroid injections of proximal insertion of the tendon of biceps muscle. Based on notes of 78 patients with algodystrophy within the hand, the incidence of shoulder complains was analysed. Evaluation of the results of the treatment of 18 patients was performed. RESULTS: 24 patients (31%) complained of pain and limited mobility in shoulder joint. In 17 of these patients (71%) algodystrophy was proceeded by fracture of the distal radius. In 16 patients shoulder complains appeared at the same time with algodystrophy of the hand and in 8 they delayed for 1-3 months. X-rays performed in all patients revealed in 3 only mild osteopenia within proximal part of humerus. All patients had proximal part of bicipital tendons of the biceps muscle tender for palpation suggesting inflammation of this tendon. In 18 patients methylprednisolone and lignocaine was injected 1-3 times locally in the vicinity of the painful tendon. In 15 of these patients (83%) treatment was successful and relief of the pain was achieved within the period from 2 days to 4 weeks. Final assessment of the treatment of algodystrophy was done mean at 13 months after the treatment was completed. Shoulder complaints disappeared in 17 from 24 patients (71%), and in 7 features persisted but were of milder intensity. These 7 patients had significantly worse final result of the treatment of the algodystrophy of the hand than rest of the group.

Adult↗
PubMed1996

Can data from the decennial census measure trends in mobility limitation among the aged?

We evaluate whether trends in the prevalence of disability among the aged can be investigated using the 1980 U.S. Census' public transportation question and the 1990 query on mobility limitation. Despite the obvious difference in the two questions, we found remarkable similarity in major cross-sectional patterns, such as those by age and sex, when comparing results from the two data sets. This result, coupled with the large number of observations available in the U.S. censuses, suggests that census data may be a suitable data source to study mobility limitation patterns in the small subgroups of the population that are frequently underrepresented in sample surveys.

Activities of Daily Living↗
PubMed2005

Lipoprotein peroxidation and mobility limitation: results from the Health, Aging, and Body Composition Study.

BACKGROUND: Oxidative damage plays an important role in leading to major health-related events. The aim of this study was to assess the predictive value of a lipoprotein peroxidation marker, oxidized low-density lipoprotein (oxLDL) for incident mobility limitation (ML). METHODS: Data are from 2985 well-functioning elders enrolled in the Health ABC study (median follow-up, 4.1 years). All oxLDL levels were measured at the baseline assessment. The oxLDL/LDL cholesterol (LDL-C) ratio (log value) was used as a measure of lipoprotein peroxidation. Mobility limitation was defined by 2 consecutive semiannual reports of any difficulty either walking 1/4 mile or climbing up 10 steps without resting. Severe ML was defined by 2 consecutive reports of great difficulty or inability to do the same tasks. Cox proportional hazards models were performed to assess hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: The mean (SD) age of the sample was 74.2 (2.9) years. After adjustment for potential confounders (sociodemographic factors, smoking, physical activity, body mass index, clinical conditions, biological markers, and medications), the relationship between the oxLDL/LDL-C ratio and disability events was statistically significant (per log-unit difference in the oxLDL/LDL-C ratio) (for ML: HR, 1.22; 95% CI, 1.06-1.41; for severe ML: HR, 1.43; 95% CI, 1.15-1.79). Consistent results were found when interleukin 6 level was included as a covariate in the adjusted models (ML: HR, 1.13; 95% CI, 0.98-1.31; severe ML: HR, 1.31; 95% CI, 1.05-1.64). No significant sex, race, interleukin 6 level, or clinical conditions interaction was found with the oxLDL/LDL-C ratio and mobility disability. CONCLUSIONS: Lipoprotein peroxidation predicts the onset of ML in older persons. The oxLDL predictive value for ML is partly explained by interleukin 6 levels.

Aged↗
PubMed2001

[Arthroscopic therapy in limited mobility of the elbow joint].

Limitation of elbow mobility constitutes a grave problem for therapy. Arthroscopy offers a therapeutic option, but in cases of loss of motion poses a considerable challenge to the operative technique. Placement of the portals already carries an increased risk of neurovascular lesions due to the altered anatomy and reduced distension capacity of the joint. Thus, particular significance attaches to the standardized arthroscopic procedure for localization and placement of the cannulas, intra-articular assessment, differentiated evaluation of the dorsal joint regions, and operative tactics for transsection of cicatrization, removal of loose bodies, and excision of osteophytes. If extra-articular factors are involved in the genesis of the limited motion, arthroscopic treatment often does not achieve the desired result. It is therefore considered propitious to differentiate the causes of the loss of motion during clinical examination with imaging diagnostics, in particular to determine those caused by extra-articular elements. If, however, individually localized intra-articular adhesive bands or loose bodies are responsible, the prognosis for arthroscopic management is clearly more favorable. Patients with minor loss of motion (> 15 degrees) profit more from the arthroscopic operation than those with a extension or flexion deficit of more than 30 degrees.

Adolescent↗
PubMed2002

Universality class of discrete solid-on-solid limited mobility nonequilibrium growth models for kinetic surface roughening.

We investigate, using the noise reduction technique, the asymptotic universality class of the well-studied nonequilibrium limited mobility atomistic solid-on-solid surface growth models introduced by Wolf and Villain (WV) and Das Sarma and Tamborenea (DT) in the context of kinetic surface roughening in ideal molecular beam epitaxy. We find essentially all the earlier conclusions regarding the universality class of DT and WV models to be severely hampered by slow crossover and extremely long-lived transient effects. We identify the correct asymptotic universality class(es) that differs from earlier conclusions in several instances.

Journal Article↗
PubMed1986

Diabetic retinopathy and its association with limited joint mobility.

Limited joint mobility (LJM) of the small joints of the hands was studied in 63 adult insulin-dependent diabetics to determine whether LJM might serve as an indicator to the presence of diabetic retinopathy in diabetics of long duration. In 123 non-diabetic controls, and in the 63 diabetics, the prevalence of LJM increased with age. In the diabetics, LJM was not associated with retinopathy, long-term glycaemic control or HLA type. The hypothesis that LJM is useful as a predictor of the development of retinopathy in young diabetics does not extend to older diabetics of long duration. LJM and retinopathy may have a different pathophysiology.

Adult↗
PubMed1986

Decreased bone density in severely handicapped children and adults, with reference to the influence of limited mobility and anticonvulsant medication.

Bone density and related biochemical parameters were investigated in institutionalised children and adults with severe handicaps, who were classified according to the degree of limited mobility (group 1, bed-ridden; group 2, capable of crawling; group 3, capable of walking) and according to whether or not they were receiving anticonvulsants. As determined by microdensitometric analysis of radiograms of the second metacarpal bone, bone width (D), bone pattern area (sigma GS) and bone salt density (sigma GS/D) were decreased in the patients, the decreases being most prominent in group 1, followed by groups 2 and 3, in that order. Significant decreases of sigma GS and sigma GS/D, but not of D, were found in patients on anticonvulsant treatment in comparison to patients without therapy. Serum alkaline phosphatase (Al-p) and parathyroid hormone (iPTH) as well as urinary calcium and cyclic adenosine-3',5'-monophosphate (cAMP) excretion were significantly increased in group 1. In comparison to patients without therapy, anticonvulsant-treated children showed significantly decreased levels of serum calcium (Ca), ionised Ca (Ca2+), 25-hydroxy vitamin D3 and urinary phosphate (PO4) excretion, and elevated levels of Al-p, iPTH and calcitonin (iCT). It is suggested that limited physical activity results in a mild hyperparathyroid state, which is aggravated in patients on anticonvulsant treatment.

Adolescent↗
PubMed1994

Pressure relief devices, risk factors, and development of pressure ulcers in elderly patients with limited mobility.

This study investigated the relationship among the use of pressure-relieving/reducing support surfaces, risk factors, and the development of pressure ulcers in 108 hospitalized, elderly patients with limited mobility. Pressure ulcers developed in 27 of the patients, even though the majority of these (96%) had used a pressure-relieving/reducing support surface. On the other hand, many patients with mobility problems, fecal incontinence, decreased serum albumin levels, and decreased total protein levels did not develop pressure ulcers.

Age Factors↗
PubMed2006

Determination of limiting mobilities and dissociation constants of 21 amino acids by capillary zone electrophoresis at very low pH.

The dependence of the effective electrophoretic mobility on pH of the background electrolyte was experimentally determined by capillary zone electrophoresis (CZE) for cationic forms of amino acids. The pH of the background electrolytes was in the highly acidic range, 1.6-2.6 pH units, to ensure a high degree of protonation of the amino acids. Poly(vinyl alcohol) was added to the background electrolytes to avoid possible adsorption of the analytes at the inner capillary wall. Non-linear regression of the experimental data was applied to obtain the parameters of the relevant regression functions--the actual mobilities and mixed dissociation constants corresponding to the actual ionic strength. The extended Onsager and Debye-Hückel law was used to calculate the limiting mobilities and thermodynamic dissociation constants. The comparison of the experimental electropherogram with the computer prediction by PeakMaster using the determined data is presented for the selected sample of amino acids.

Amino Acids↗