A study conducted at UFSCar (Federal University of São Carlos) suggests that health professionals can detect very early functional decline in an elderly patient, that is, a reduction in the ability to perform day-to-day tasks independently, observing their 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 the American Journal of Clinical Nutrition, this indicator is valid mainly for men with abdominal obesity and muscle weakness.
The study was carried out during Roberta de Oliveira Máximo’s doctorate at the Graduate Program in Physiotherapy at UFSCar, with support from 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 English people 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 pre-clinical 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 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 slow walking can be considered, in isolation, an indicator of increased risk for loss of ability to perform daily activities (read more at: agencia.FAPESP.br/37887).
“The worst performance in the SPPB seems to be something even earlier than the slowness in walking speed”, say the UFSCar researchers.
Different types of obesity
According to the new study, only a specific group of older men had a 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 is 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 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 assessing abdominal obesity, overall obesity is assessed by body mass index (BMI, calculated by dividing a 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 assessment, one of the main messages of the research is that the identification and clinical management of the dynapenic abdominal obesity phenotype is essential to avoid the first 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”, recommends the researcher.
“The approach to be adopted, according to the 2020 World Health Organization guidelines, is for seniors, aged 65 and over, to incorporate a variety of aerobic exercise and muscle-strengthening activities. Seniors should do at least 150 to 300 minutes of moderate-intensity exercise or 75 or 150 minutes of vigorous aerobic exercise throughout the week As part of their weekly physical activity, older adults should also do strength training that engages all major muscle groups three or more days a week “, he concludes.
The research also received funding from FAPESP through a Research Grant – Support for Young Researchers granted to Alexandre.