Assessing Muscle Function and Balance Problems at Home, in the

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Assessing Muscle Function and Balance Problems

at Home, in the Clinic, and in Research 25th IOA Colloquium on Aging

September 17, 2013

Bjoern Buehring, M.D. University of Wisconsin School of Medicine and Public Health

GRECC, William S. Middleton Memorial Veterans Hospital Madison, WI, USA

Disclosures/Conflicts of Interest

None

Outline  How independent and active are older

Americans?  Muscle and Biomechanics 101  How do you know how well your muscles

work?  The impact of poor muscle function on

health

Activities of Daily Living are Parameters of Independence and Mobility

Activity of Daily Living Instrumental Activities of Daily Living

Personal hygiene and grooming Taking medications as prescribed

Bowel and bladder management Managing money

Self feeding Use of telephone or other technology

Dressing and undressing Housework

Functional transfers (getting into and out of bed or wheelchair, getting onto or off toilet, etc.)

Shopping for groceries or clothing

Ambulation (walking with or without use of an assistive device)

Transportation within the community

Impaired Function is Common in Older Adults

http://www.agingstats.gov/agingstatsdotnet/Main_Site/Data/2012_Documents/Docs/EntireChartbook.pdf#page=140

  Several governmental and non-governmental agencies collect survey and health data on older adults

  The “Older Americans 2012: Key Indicators of Well-Being” report by the Federal Interagency Forum on Aging-Related Statistics (Forum) summarizes several of these indicators

  Data presented here are based on:   Centers for Medicare and Medicaid Services   Medicare Current Beneficiary Survey   Centers for Disease Control and Prevention   National Center for Health Statistics   National Health Interview Survey



120

INDICATOR 20 Functional LimitationsTable 20a. Percentage of Medicare enrollees age 65 and over who have limitations in activities of daily living (ADLs) or

instrumental activities of daily living (IADLs), or who are in a long-term care facility, selected years 1992–2009

1992 1997 2001 2005 2007 2009

Total 48.8 42.5 43.7 42.1 42.2 41.4

IADLs only

1–2 ADLs

13.7

19.6

12.7

16.6

13.4

17.2

12.3

18.3

13.8

17.7

12.1

17.6

3–4 ADLs 6.1 4.9 5.3 4.7 4.5 5.1

5–6 ADLs 3.5 3.2 3.0 2.5 2.3 2.7

Long-term care facility 5.9 5.1 4.8 4.3 3.9 3.9

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Table 20b. Percentage of Medicare enrollees age 65 and over who have limitations in activities of daily living (ADLs) or

instrumental activities of daily living (IADLs), or who are in a long-term care facility, by sex, 2009

Both Sexes Men Women

Total 41.4 35.5 45.8

IADLs only 12.1 9.5 14.2

1–2 ADLs 17.6 16.1 18.8

3–4 ADLs 5.1 4.3 5.8

5–6 ADLs 2.7 2.7 2.6

Long-term care facility 3.9 2.9 4.4

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120

INDICATOR 20 Functional LimitationsTable 20a. Percentage of Medicare enrollees age 65 and over who have limitations in activities of daily living (ADLs) or

instrumental activities of daily living (IADLs), or who are in a long-term care facility, selected years 1992–2009

1992 1997 2001 2005 2007 2009

Total 48.8 42.5 43.7 42.1 42.2 41.4

IADLs only

1–2 ADLs

13.7

19.6

12.7

16.6

13.4

17.2

12.3

18.3

13.8

17.7

12.1

17.6

3–4 ADLs 6.1 4.9 5.3 4.7 4.5 5.1

5–6 ADLs 3.5 3.2 3.0 2.5 2.3 2.7

Long-term care facility 5.9 5.1 4.8 4.3 3.9 3.9

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Table 20b. Percentage of Medicare enrollees age 65 and over who have limitations in activities of daily living (ADLs) or

instrumental activities of daily living (IADLs), or who are in a long-term care facility, by sex, 2009

Both Sexes Men Women

Total 41.4 35.5 45.8

IADLs only 12.1 9.5 14.2

1–2 ADLs 17.6 16.1 18.8

3–4 ADLs 5.1 4.3 5.8

5–6 ADLs 2.7 2.7 2.6

Long-term care facility 3.9 2.9 4.4

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121

Tables

INDICATOR 20 Functional LimitationsTable 20c. Percentage of Medicare enrollees age 65 and over who are unable to perform certain physical functions, by

sex, 1991 and 2009

Function 1991 2009

Men

Stoop/kneel 8.0 10.2

Reach over head 3.1 3.1

Write/grasp small objects 2.3 1.5

Walk 2–3 blocks 14.2 14.5

Lift 10 lbs. 9.4 7.1

$Q\�RI�WKHVH�¿YH 19.1 19.0

Women





Lift 10 lbs. 18.4 13.5

$Q\�RI�WKHVH�¿YH 32.0 29.7NOTES: Rates for 1991 are age-adjusted to the 2009 population.Reference population: These data refer to Medicare enrollees.6285&(��&HQWHUV�IRU�0HGLFDUH�DQG�0HGLFDLG�6HUYLFHV��0HGLFDUH�&XUUHQW�%HQH¿FLDU\�6XUYH\�

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Selected characteristic Men Women

Age

65–74 12.9 18.7

75–84 22.1 33.7

85 and over 39.6 53.0

Race

White, not Hispanic or Latino 18.4 28.6

Black, not Hispanic or Latino 23.1 33.4

Hispanic or Latino (any race) 20.4 33.6127(��7KH�¿YH�SK\VLFDO�IXQFWLRQV�LQFOXGH�VWRRSLQJ�NQHHOLQJ��UHDFKLQJ�RYHU�WKH�KHDG��ZULWLQJ�JUDVSLQJ�VPDOO�REMHFWV��ZDONLQJ��±��EORFNV��DQG�OLIWLQJ��OEV�Reference population: These data refer to Medicare enrollees.6285&(��&HQWHUV�IRU�0HGLFDUH�DQG�0HGLFDLG�6HUYLFHV��0HGLFDUH�&XUUHQW�%HQH¿FLDU\�6XUYH\�

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121

Tables

INDICATOR 20 Functional LimitationsTable 20c. Percentage of Medicare enrollees age 65 and over who are unable to perform certain physical functions, by

sex, 1991 and 2009

Function 1991 2009

Men





Lift 10 lbs. 9.4 7.1

$Q\�RI�WKHVH�¿YH 19.1 19.0

Women





Lift 10 lbs. 18.4 13.5

$Q\�RI�WKHVH�¿YH 32.0 29.7NOTES: Rates for 1991 are age-adjusted to the 2009 population.Reference population: These data refer to Medicare enrollees.6285&(��&HQWHUV�IRU�0HGLFDUH�DQG�0HGLFDLG�6HUYLFHV��0HGLFDUH�&XUUHQW�%HQH¿FLDU\�6XUYH\�

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Selected characteristic Men Women

Age

65–74 12.9 18.7

75–84 22.1 33.7

85 and over 39.6 53.0

Race

White, not Hispanic or Latino 18.4 28.6

Black, not Hispanic or Latino 23.1 33.4

Hispanic or Latino (any race) 20.4 33.6127(��7KH�¿YH�SK\VLFDO�IXQFWLRQV�LQFOXGH�VWRRSLQJ�NQHHOLQJ��UHDFKLQJ�RYHU�WKH�KHDG��ZULWLQJ�JUDVSLQJ�VPDOO�REMHFWV��ZDONLQJ��±��EORFNV��DQG�OLIWLQJ��OEV�Reference population: These data refer to Medicare enrollees.6285&(��&HQWHUV�IRU�0HGLFDUH�DQG�0HGLFDLG�6HUYLFHV��0HGLFDUH�&XUUHQW�%HQH¿FLDU\�6XUYH\�

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Watching TV is THE Leisure Activity of Older Adults


133

Tables

INDICATOR 28 Use of TimeTable 28a. Average number of hours per day and percentage of day that people age 55 and over spent doing selected

activities on an average day, by age group, 2010

55–64 65–74 75 and over

Selected activities

Average hours

per dayPercent

of day

Average hours

per dayPercent

of day

Average hours Percent

per day of day

Sleeping

Leisure activities

Work and work-related activities

Household activities

Caring for and helping others

Eating and drinking

Purchasing goods and services

Grooming

Other activities

8.5

5.2

3.8

2.1

0.4

1.3

0.8

0.7

1.2

35.4

21.8

16.0

8.6

1.6

5.4

3.5

2.7

4.8

8.8

6.9

1.2

2.4

0.4

1.4

0.9

0.6

1.4

36.6

28.6

4.8

10.0

1.8

5.9

3.9

2.7

5.9

9.3

7.7

0.2

2.3

0.2

1.5

0.7

0.6

1.4

38.8

32.0

1.0

9.6

0.7

6.4

3.1

2.6

5.9

NOTE: “Other activities” includes activities such as educational activities; organizational, civic and religious activities; and telephone calls. Table includes people who did not

work at all.

Reference population: These data refer to the civilian noninstitutionalized population.

SOURCE: Bureau of Labor Statistics, American Time Use Survey.

Table 28b. Average number of hours and percentage of total leisure time that people age 55 and over spent doing selected leisure activities on an average day, by age group, 2010

55–64 65–74 75 and over

Average Average Average hours Percent of hours Percent of hours Percent of

Selected leisure activities per day leisure time per day leisure time per day leisure time

Socializing and communicating 0.6 11.3 0.7 10.3 0.6 8.0

Watching TV 3.0 57.8 3.8 55.6 4.4 57.7

Participation in sports, exercise,

and recreation 0.3 4.9 0.3 4.3 0.2 3.0

Relaxing and thinking 0.3 5.2 0.5 7.8 0.7 8.6

Reading 0.4 7.1 0.6 9.5 0.9 12.2

Other leisure activities 0.7 13.7 0.8 12.2 0.8 10.6

NOTE: “Other leisure activities” includes activities such as playing games, using the computer for leisure, arts and crafts as a hobby, arts and entertainment (other than sports),

and related travel.

Reference population: These data refer to the civilian noninstitutionalized population.

SOURCE: Bureau of Labor Statistics, American Time Use Survey.

Aerobic and Strength Training is Uncommon in Older Adults


125

Tables

INDICATOR 24 Physical ActivityTable 24a. Percentage of people age 45 and over who reported participating in leisure-time aerobic and muscle-

strengthening activities that meet the 2008 Federal physical activity guidelines, by age group, 1998–2010

Year 45–64 65 and over 65–74 75–84 85 and over

1998 11.4 5.5 7.0 3.9 2.0

1999 11.9 5.9 7.7 4.5 0.9

2000 12.8 6.9 8.4 5.7 1.9

2001 13.1 6.7 7.7 6.1 3.1

2002 14.2 7.1 8.8 5.8 2.1

2003 14.6 7.6 9.2 6.7 2.9

2004 14.0 7.8 9.7 6.4 3.5

2005 14.4 7.9 10.5 5.7 3.0

2006 13.8 7.5 9.1 6.5 3.0

2007 15.0 7.9 9.5 6.6 4.1

2008 16.3 9.5 11.3 9.3 2.3

2009 16.9 10.0 12.8 7.9 2.8

2010 17.8 10.5 13.6 7.3 4.0NOTE: This measure of physical activity differs from previous editions of Older Americans. 7KH�PHDVXUH�UHÀHFWV�WKH��)HGHUDO�3K\VLFDO�$FWLYLW\�*XLGHOLQHV�IRU�$PHULFDQV�(available from: KWWS��ZZZ�KHDOWK�JRY�3$*XLGHOLQHV��7KH��)HGHUDO�JXLGHOLQHV�UHFRPPHQG�WKDW�IRU�VXEVWDQWLDO�KHDOWK�EHQH¿WV��DGXOWV�SHUIRUP�DW�OHDVW��PLQXWHV��KRXUV�DQG��PLQXWHV��D�ZHHN�RI�PRGHUDWH�LQWHQVLW\��RU��PLQXWHV��KRXU�DQG��PLQXWHV��D�ZHHN�RI�YLJRURXV�LQWHQVLW\�DHURELF�SK\VLFDO�DFWLYLW\��RU�DQ�HTXLYDOHQW�FRPELQDWLRQ�of moderate- and vigorous-intensity aerobic activity. Aerobic activity should be performed in episodes of at least 10 minutes, and preferably, it should be spread throughout the ZHHN��7KH��JXLGHOLQHV�DOVR�UHFRPPHQG�WKDW�DGXOWV�SHUIRUP�PXVFOH�VWUHQJWKHQLQJ�DFWLYLWLHV�WKDW�DUH�PRGHUDWH�RU�KLJK�LQWHQVLW\�DQG�LQYROYH�DOO�PDMRU�PXVFOH�JURXSV�RQ�WZR�RU�PRUH�GD\V�D�ZHHN��EHFDXVH�WKHVH�DFWLYLWLHV�SURYLGH�DGGLWLRQDO�KHDOWK�EHQH¿WV��7KH�PHDVXUH�VKRZQ�KHUH�SUHVHQWV�WKH�SHUFHQWDJH�RI�SHRSOH�ZKR�IXOO\�PHW�ERWK�WKH�DHURELF�activity and muscle-strengthening guidelines.5HIHUHQFH�SRSXODWLRQ��7KHVH�GDWD�UHIHU�WR�WKH�FLYLOLDQ�QRQLQVWLWXWLRQDOL]HG�SRSXODWLRQ�6285&(��&HQWHUV�IRU�'LVHDVH�&RQWURO�DQG�3UHYHQWLRQ��1DWLRQDO�&HQWHU�IRU�+HDOWK�6WDWLVWLFV��1DWLRQDO�+HDOWK�,QWHUYLHZ�6XUYH\�

Table 24b. Percentage of people age 65 and over who reported participating in leisure-time aerobic and muscle- strengthening activities that meet the 2008 Federal physical activity guidelines, by sex and race and ethnicity, 2010

Aerobic activity only

All White, not Hispanic or Latino Black, not Hispanic or Latino Hispanic or Latino

Both sexes 10.5 11.5 5.2 5.6

Men 13.6 14.6 7.8 9.0

Women 8.0 9.0 3.6 3.0NOTE: This measure of physical activity differs from previous editions of Older Americans.�7KH�PHDVXUH�UHÀHFWV�WKH��)HGHUDO�3K\VLFDO�$FWLYLW\�*XLGHOLQHV�IRU�$PHULFDQV�(available from: KWWS��ZZZ�KHDOWK�JRY�3$*XLGHOLQHV��7KH��)HGHUDO�JXLGHOLQHV�UHFRPPHQG�WKDW�IRU�VXEVWDQWLDO�KHDOWK�EHQH¿WV��DGXOWV�SHUIRUP�DW�OHDVW��PLQXWHV��KRXUV�DQG��PLQXWHV��D�ZHHN�RI�PRGHUDWH�LQWHQVLW\��RU��PLQXWHV��KRXU�DQG��PLQXWHV��D�ZHHN�RI�YLJRURXV�LQWHQVLW\�DHURELF�SK\VLFDO�DFWLYLW\��RU�DQ�HTXLYDOHQW�FRPELQDWLRQ�of moderate- and vigorous-intensity aerobic activity. Aerobic activity should be performed in episodes of at least 10 minutes, and preferably, it should be spread throughout the ZHHN��7KH��JXLGHOLQHV�DOVR�UHFRPPHQG�WKDW�DGXOWV�SHUIRUP�PXVFOH�VWUHQJWKHQLQJ�DFWLYLWLHV�WKDW�DUH�PRGHUDWH�RU�KLJK�LQWHQVLW\�DQG�LQYROYH�DOO�PDMRU�PXVFOH�JURXSV�RQ�WZR�RU�PRUH�GD\V�D�ZHHN��EHFDXVH�WKHVH�DFWLYLWLHV�SURYLGH�DGGLWLRQDO�KHDOWK�EHQH¿WV��7KH�PHDVXUH�VKRZQ�KHUH�SUHVHQWV�WKH�SHUFHQWDJH�RI�SHRSOH�ZKR�IXOO\�PHW�ERWK�WKH�DHURELF�activity and muscle-strengthening guidelines.5HIHUHQFH�SRSXODWLRQ��7KHVH�GDWD�UHIHU�WR�WKH�FLYLOLDQ�QRQLQVWLWXWLRQDOL]HG�SRSXODWLRQ�6285&(��&HQWHUV�IRU�'LVHDVH�&RQWURO�DQG�3UHYHQWLRQ��1DWLRQDO�&HQWHU�IRU�+HDOWK�6WDWLVWLFV��1DWLRQDO�+HDOWK�,QWHUYLHZ�6XUYH\�

Aerobic and Strength Training is Uncommon in Older Adults


125

Tables

INDICATOR 24 Physical ActivityTable 24a. Percentage of people age 45 and over who reported participating in leisure-time aerobic and muscle-

strengthening activities that meet the 2008 Federal physical activity guidelines, by age group, 1998–2010

Year 45–64 65 and over 65–74 75–84 85 and over

1998 11.4 5.5 7.0 3.9 2.0

1999 11.9 5.9 7.7 4.5 0.9

2000 12.8 6.9 8.4 5.7 1.9

2001 13.1 6.7 7.7 6.1 3.1

2002 14.2 7.1 8.8 5.8 2.1

2003 14.6 7.6 9.2 6.7 2.9

2004 14.0 7.8 9.7 6.4 3.5

2005 14.4 7.9 10.5 5.7 3.0

2006 13.8 7.5 9.1 6.5 3.0

2007 15.0 7.9 9.5 6.6 4.1

2008 16.3 9.5 11.3 9.3 2.3

2009 16.9 10.0 12.8 7.9 2.8

2010 17.8 10.5 13.6 7.3 4.0NOTE: This measure of physical activity differs from previous editions of Older Americans. 7KH�PHDVXUH�UHÀHFWV�WKH��)HGHUDO�3K\VLFDO�$FWLYLW\�*XLGHOLQHV�IRU�$PHULFDQV�(available from: KWWS��ZZZ�KHDOWK�JRY�3$*XLGHOLQHV��7KH��)HGHUDO�JXLGHOLQHV�UHFRPPHQG�WKDW�IRU�VXEVWDQWLDO�KHDOWK�EHQH¿WV��DGXOWV�SHUIRUP�DW�OHDVW��PLQXWHV��KRXUV�DQG��PLQXWHV��D�ZHHN�RI�PRGHUDWH�LQWHQVLW\��RU��PLQXWHV��KRXU�DQG��PLQXWHV��D�ZHHN�RI�YLJRURXV�LQWHQVLW\�DHURELF�SK\VLFDO�DFWLYLW\��RU�DQ�HTXLYDOHQW�FRPELQDWLRQ�of moderate- and vigorous-intensity aerobic activity. Aerobic activity should be performed in episodes of at least 10 minutes, and preferably, it should be spread throughout the ZHHN��7KH��JXLGHOLQHV�DOVR�UHFRPPHQG�WKDW�DGXOWV�SHUIRUP�PXVFOH�VWUHQJWKHQLQJ�DFWLYLWLHV�WKDW�DUH�PRGHUDWH�RU�KLJK�LQWHQVLW\�DQG�LQYROYH�DOO�PDMRU�PXVFOH�JURXSV�RQ�WZR�RU�PRUH�GD\V�D�ZHHN��EHFDXVH�WKHVH�DFWLYLWLHV�SURYLGH�DGGLWLRQDO�KHDOWK�EHQH¿WV��7KH�PHDVXUH�VKRZQ�KHUH�SUHVHQWV�WKH�SHUFHQWDJH�RI�SHRSOH�ZKR�IXOO\�PHW�ERWK�WKH�DHURELF�activity and muscle-strengthening guidelines.5HIHUHQFH�SRSXODWLRQ��7KHVH�GDWD�UHIHU�WR�WKH�FLYLOLDQ�QRQLQVWLWXWLRQDOL]HG�SRSXODWLRQ�6285&(��&HQWHUV�IRU�'LVHDVH�&RQWURO�DQG�3UHYHQWLRQ��1DWLRQDO�&HQWHU�IRU�+HDOWK�6WDWLVWLFV��1DWLRQDO�+HDOWK�,QWHUYLHZ�6XUYH\�

Table 24b. Percentage of people age 65 and over who reported participating in leisure-time aerobic and muscle- strengthening activities that meet the 2008 Federal physical activity guidelines, by sex and race and ethnicity, 2010

Aerobic activity only

All White, not Hispanic or Latino Black, not Hispanic or Latino Hispanic or Latino

Both sexes 10.5 11.5 5.2 5.6

Men 13.6 14.6 7.8 9.0

Women 8.0 9.0 3.6 3.0NOTE: This measure of physical activity differs from previous editions of Older Americans.�7KH�PHDVXUH�UHÀHFWV�WKH��)HGHUDO�3K\VLFDO�$FWLYLW\�*XLGHOLQHV�IRU�$PHULFDQV�(available from: KWWS��ZZZ�KHDOWK�JRY�3$*XLGHOLQHV��7KH��)HGHUDO�JXLGHOLQHV�UHFRPPHQG�WKDW�IRU�VXEVWDQWLDO�KHDOWK�EHQH¿WV��DGXOWV�SHUIRUP�DW�OHDVW��PLQXWHV��KRXUV�DQG��PLQXWHV��D�ZHHN�RI�PRGHUDWH�LQWHQVLW\��RU��PLQXWHV��KRXU�DQG��PLQXWHV��D�ZHHN�RI�YLJRURXV�LQWHQVLW\�DHURELF�SK\VLFDO�DFWLYLW\��RU�DQ�HTXLYDOHQW�FRPELQDWLRQ�of moderate- and vigorous-intensity aerobic activity. Aerobic activity should be performed in episodes of at least 10 minutes, and preferably, it should be spread throughout the ZHHN��7KH��JXLGHOLQHV�DOVR�UHFRPPHQG�WKDW�DGXOWV�SHUIRUP�PXVFOH�VWUHQJWKHQLQJ�DFWLYLWLHV�WKDW�DUH�PRGHUDWH�RU�KLJK�LQWHQVLW\�DQG�LQYROYH�DOO�PDMRU�PXVFOH�JURXSV�RQ�WZR�RU�PRUH�GD\V�D�ZHHN��EHFDXVH�WKHVH�DFWLYLWLHV�SURYLGH�DGGLWLRQDO�KHDOWK�EHQH¿WV��7KH�PHDVXUH�VKRZQ�KHUH�SUHVHQWV�WKH�SHUFHQWDJH�RI�SHRSOH�ZKR�IXOO\�PHW�ERWK�WKH�DHURELF�activity and muscle-strengthening guidelines.5HIHUHQFH�SRSXODWLRQ��7KHVH�GDWD�UHIHU�WR�WKH�FLYLOLDQ�QRQLQVWLWXWLRQDOL]HG�SRSXODWLRQ�6285&(��&HQWHUV�IRU�'LVHDVH�&RQWURO�DQG�3UHYHQWLRQ��1DWLRQDO�&HQWHU�IRU�+HDOWK�6WDWLVWLFV��1DWLRQDO�+HDOWK�,QWHUYLHZ�6XUYH\�

Muscle 101   The musculoskeletal system is

needed for locomotion and posture

  It consists of several tissues including bone, muscle, joints, ligaments and tendons

  Muscle is attached to bone through tendons

  Muscle contractions lead to body movement

www.orthoinfo.aaos.org, www.predatornutrition.com

Muscle 101   Muscle cells (or fibers) are

long and are grouped into fascicles

  Several fascicles make up a muscle

  Muscle cells contain proteins that move within the cell and shorten their length

  The nervous system is responsible for initiating, controlling and coordinating contractions

http://www.sciencelearn.org.nz

Biomechanics 101   There are different types of muscle contractions

 Concentric = muscle shortens as it contracts  Eccentric = muscle lengthens as it contracts   Isometric = muscle remains at the same length

Biomechanics 101   Force (F, Newton) = Mass (m, kilogram) x Acceleration (a,

meters/second2)

  Velocity (v, meters/second) = Distance (d, meters) / Time (t, seconds)

  Power (P, Watts) = Force (F, Newton) x Velocity (v, meters/second) = Work (W, Joule) / Time (t, seconds)

  Sway can be measured in “Path length” (Length, meters) or “Area of Sway” (Area, meter2)

Grip Strength  Can you open a jar?

 Power grip (232.8 N), Precision grip (248.6 N)

Kuo, Proc Inst Mech Eng H, 2009 http://bobonews.tumblr.com/

Grip Strength  Grip strength is measured with a

dynamometer   It is an isometric

contraction   It measures

maximal force

http://www.physicalcompany.co.uk

Leg Power  Can you get up

  from a chair?  out of bed?  out of a car?

http://www.avin.ca/

Leg Power   Leg power can be measured with

  the repeated chair rise test

  the get up and go test

 Power assesses muscle force and speed (velocity)

http://tle.tafevc.com.au

Leg Power  Repeated chair rises can be measured with

a stop watch or force platform

http://www.galileo-training.com

Gait speed   How long does it take you to cross the street?

  Distance: 28 meters (91.9 feet)   Time the light is green: 20 seconds (plus 10 seconds of

flashing)

  Although walking requires muscle power it is largely dependent on velocity (not force)

Gait speed  How long does it take you to cross the

street?   If gait speed is:

  1.3 m/s à 21.5 seconds   1.0 m/s à 28 seconds   0.8 m/s à 35 seconds   0.5 m/s à 56 seconds

Gait speed

Balance / Sway  Do you have difficulties getting out of a

bathtub?

http://i.ytimg.com/vi/9afRaaNXpbY/0.jpg

Balance / Sway  Balance and Sway can be measured with

 The Romberg stance test  The semi-tandem and tandem stance test  The functional reach test  On a force platform

Balance / Sway  The Romberg and Tandem Stance tests

 These tests examine static balance

http://drxuacupuncture.wordpress.com http://www.osceskills.com/

Balance / Sway  The functional reach

test  This test examines

dynamic balance   Individuals are asked

to lean forward as far as they can without taking a step forward

Pérennou, 2005

Balance / Sway  Sway can be quantified with a force platform

http://www.galileo-training.com

How Do you Measure Muscle Mass and Function?  Muscle mass is often measured by dual

energy x-ray absorptiometry (DXA)

http://info.blockimaging.com

Measuring Muscle and Fat with DXA

•  Individuals with the same body mass index can have different body composition

•  Older individuals have more fat mass and lower muscle mass

Cut-off values for muscle function tests Muscle function test Cut-off

Grip strength (dynamometer) Females: <20kg; Males: <30kg

Chair rise (5 chair rises) > 11.5 – 15 seconds (depending on age and gender)

Get up and go (get up from chair walk 10 feet, turn around, walk back and sit down)

Females and Males > 12 seconds

Walking speed (20 feet) Females and males < 0.8 – 1.0 m/s Romberg, (semi-) tandem stance Able to stand for 60 (or 30) seconds

Functional reach (leaning forward) < 6-7 inches

Muscle mass (DXA appendicular lean mass, arms + legs)

Females: <5.45 kg/m2 Males < 7.45 kg/m2

Grip Strength is Associated with ADLs / IADLs

Rantanen, JAMA, 1999, 10;281(6):558-60

§  6089 45 to 68-year-old healthy men had grip strength measured 1965 through 1970

§  3218 surviving

participants had disability assessment 25 years later

Impaired Physical Performance Increases Hip Fracture Risk

Adapted from Cawthon, et. al., J Bone Miner Res, 2008, 23:1037-1044

Data from the MrOS study, which included 5995 men age 65+

Slow Walking Speed is Associated with Increased Mortality

Cesari, J Gerontol A Biol Sci Med Sci, 2009, 64:377-84

  Relationship of walking speed and mortality

  InChianti Study (Aging in the Chianti area study), started 1998, ~1,150 participants, between ages 65 and 102

Summary

  Impaired physical function is common in older adults

  The (Neuro-) Musculoskeletal system consists of many tissues including bones, muscles, joints and the nervous system

  Muscle contractions are the origin of movement   Muscle functions include force, power, speed and

balance   Poor muscle function is associated with decreased

physical function, hospitalizations and death

Thank You