A new study says the early detection of functional decline is possible by watching older patients perform simple tasks, such as walking short distances and sitting down or getting up from a chair.
According to researchers, the findings, published in The American Journal of Clinical Nutrition, are valid mainly for the ability of older men who have abdominal obesity and a loss of muscle strength (known as dynapenia) to perform basic daily tasks without assistance.
“Impaired physical performance is the first sign of functional decline in the elderly,” said Tiago da Silva Alexandre, a professor at the Federal University of São Carlos in Brazil who supervised the research. “It’s considered a pre-clinical transition stage toward incapacity, appearing before difficulties are experienced with everyday activities such as using public transport, shopping, doing housework, cooking, bathing, getting dressed, and taking meals.
“Early diagnosis could help prevent older people from becoming unable to perform these day-to-day tasks.”
Researchers studied eight years of data for 3,875 individuals aged 60 or older who were included in the English Longitudinal Study of Ageing (ELSA). The assessment of physical function was determined by the Short Physical Performance Battery (SPPB), a widely used test that includes, among other measures, gait speed while walking 2.4 metres, static balance and a sit-to-stand test.
The study defined dynapenic abdominal obesity in men as a waist circumference of more than 102 centimetres and a handgrip (a measure used for overall strength) of less than 26 kilograms. For women, this equated to a waist circumference of 88 cm or more and a handgrip of less than 16 kg. The test, which takes about 15 minutes to complete, is a vital tool for assessing older patients and can provide a wealth of information.
Men lose more muscle strength than women
The team found impairment of physical performance due to dynapenic abdominal obesity to be much more common in men than women. “Men and women alike lose muscle strength and accumulate abdominal fat as they age, but the situation is worse for men,” said Roberta de Oliveira Máximo, who conducted the study as part of his PhD research. “Men lose more muscle strength than women during their lifetime and tend to accumulate abdominal fat even before they’re elderly. Abdominal fat is more active metabolically and generates low-level inflammation, with negative repercussions for muscle function.
“This explains the differences between the sexes and why dynapenic abdominal obesity affects physical performance more in men.”
When dynapenia was combined with general obesity as defined by body mass index (BMI) instead of waist circumference, however, it did not correlate with a decline in physical performance among men or women. According to researchers, this shows that obesity as determined by BMI does not account for the impact age-related changes in body-fat distribution has on physical performance.
They also found that neither abdominal obesity nor dynapenia were associated with worsening physical performance over time when they were assessed separately and that doing so may underestimate the extent of age-related functional decline.
“The clinical importance of these findings is that although dynapenic abdominal obesity is an age-related condition, it is potentially modifiable and neglecting it has major repercussions for functional status, especially in men,” Máximo said. “The 2020 World Health Organization guidelines recommend that men aged 65 or more should regularly perform a number of aerobic exercises and muscle-strengthening activities. They should get at least 150 to 300 minutes of moderately intense exercise or 75 to 150 minutes of vigorous aerobic exercise each week.
“As part of their weekly physical activity, they should also practice strength training of all the main muscle groups on three or more days each week.”
Dave Yasvinski is a writer with Healthing.ca