A study conducted at the Federal University of São Carlos (UFSCar) suggests that health professionals can early detect functional decline in an elderly patient, that is, the reduced ability to perform day-to-day tasks independently, observing your performance in simple tasks, such as sitting in and out of a chair, standing still, or walking a short distance. According to the research, published in American Journal of Clinical Nutritionthis indicator is valid mainly for men with abdominal obesity and muscle weakness.
The study was carried out during Roberta de Oliveira Máximo’s doctorate in the Postgraduate Program in Physiotherapy at UFSCar, with support from the Fundação de Amparo à Pesquisa do Estado de São Paulo (Fapesp) and guidance from Professor Tiago da Silva Alexandre. And it had the participation of researchers from University College London, in the United Kingdom. The group analyzed data from 3,875 elderly Englishmen followed for eight years. The volunteers had their physical performance evaluated by the Short Physical Performance Battery (SPPB), a battery of tests known to health professionals that includes a combination of sitting and rising from a chair, static balance and walking for 2.4 meters.
“The impairment in physical performance is the first indicator of impaired function in the elderly and is considered a preclinical transition phase to disability, that is, it appears before difficulties in daily activities, such as using transportation, shopping, taking care of the house and clothes, prepare meals, shower, get dressed, go to the bathroom and eat”, says Alexandre. “Thus, its early discovery could prevent impairments in activities of daily living in this population.”
As the researcher explains, physical performance (or physical functional performance) is an objective assessment of functional status, which involves performing a specific task evaluated by predetermined criteria (scores, repetition count or activity time). It differs from the subjective assessment of functional status, which involves self-reporting of functional activities that the individual does or does not do.
Impairment in physical performance is considered as the sixth vital sign in the evaluation of the elderly. Applying the full SPPB battery takes about 15 minutes and may have some additional explanatory power to the isolated walking speed test, at the expense of a little more application time.
In a previous work, the group had demonstrated that the slowness when walking can be considered, in isolation, an indicator of increased risk for loss of ability to perform daily activities.
“The worst performance in the SPPB seems to be something even earlier than the slowness in walking speed”, say the UFSCar researchers.
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Different types of obesity
According to the new study, only a specific group of elderly men showed greater impairment in physical performance over the follow-up time: those who had a combination of abdominal obesity and muscle weakness — a condition known as dynapenia. This phenotype is common among the elderly and recognized in the scientific community by the name of “dynapenic abdominal obesity”.
In the research, this condition was characterized by waist circumference above 102 cm for men and greater than 88 cm for women, as well as handgrip strength below 26 kg for men and less than 16 kg for women. This last parameter is measured through a test in which the volunteer squeezes a device called a dynamometer with his hands. The values obtained in the test are used as a reference to analyze muscle strength throughout the body.
“With the aging process, men and women experience loss of muscle strength accompanied by an accumulation of abdominal fat. However, the situation is worse for men. Men lose more muscle strength than women throughout their lives and they already have a tendency to accumulate abdominal fat even before the aging process. Abdominal fat is more metabolically active and generates chronic low-grade inflammation, leading to negative repercussions on muscle function. This explains the differences between the sexes and the reason why dynapenic abdominal obesity affects physical performance more in men”, explains Máximo.
The situation is different when, instead of evaluating abdominal obesity, one evaluates the general obesity by body mass index (BMI, calculated by dividing the person’s weight by height squared). In this case, general obesity combined with dynapenia was not related to the worst trajectory of physical performance in either men or women, suggesting that the assessment of obesity by BMI is not able to capture the changes in body fat distribution that occur with aging. and that impact physical performance.
The study brings another important finding: neither abdominal obesity nor dynapenia alone were associated with worse physical performance in the elderly over time, demonstrating that taking into account the separate assessment of these two conditions instead of the dynapenic abdominal obesity phenotype may underestimate a real future problem of decreased physical performance in the elderly.
In Alexandre’s opinion, one of the main messages of the research is that the identification and clinical management of the dynapenic abdominal obesity phenotype are essential for prevent early signs of functional decline in elderly men.
“The clinical importance of this finding is that, although dynapenic abdominal obesity is a condition associated with aging, it is potentially modifiable. But when neglected, it has important repercussions on functional status, especially in men. The approach to be adopted, according to the 2020 World Health Organization guidelines, is for the elderly, aged 65 and over, to incorporate a variety of aerobic exercises and muscle-strengthening activities. Seniors should get at least 150 to 300 minutes of moderate-intensity exercise or 75 to 150 minutes of vigorous aerobic exercise throughout the week. As part of their weekly physical activity, older adults should also do strength training that involves all major muscle groups on three or more days a week.
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