Daily Archives: 8 July 2024

Maintaining Leg Strength in Retirement Through Heavy Resistance Training

Depletion of leg muscle strength has emerged as a robust predictor of mortality among older adults, underscoring the critical need for its preservation. However, there is hope in the form of resistance training, which can mitigate this decline. As individuals age, skeletal muscle mass and function naturally decline, often compromising mobility and autonomy. While existing research has predominantly focused on relatively short-term interventions spanning 6 to 9 months, there is potential for longer-term solutions.

In an effort to explore the enduring effects of prolonged, supervised resistance training, researchers conducted a follow-up study involving participants from the lIve active Successful Ageing (LISA) trial—a large-scale, randomised controlled trial. This investigation aimed to ascertain whether engaging in one year of rigorous resistance training with heavy loads could yield sustained benefits over an extended period, providing reassurance about the long-term effectiveness of this intervention.

Participants recently retired and in good health, were initially categorised by sex, BMI, and independent chair mobility before being randomly allocated to one of three groups: a heavy weightlifting regimen performed three times weekly (149 participants), a moderate intensity training programme incorporating bodyweight exercises and resistance bands (154 participants, also three times weekly), or a comparison group (148 participants) advised to maintain their usual physical activity levels.

Baseline measurements encompassed bone and muscle strength, as well as body fat levels, with subsequent assessments conducted at 1, 2, and 4 years post-intervention. After the study period, 369 participants remained available for evaluation, reflecting an attrition rate primarily attributable to lack of motivation or illness.

By the fourth year, participants averaged 71 years of age, predominantly female (61%), and sustained an active lifestyle equivalent to nearly 10,000 daily steps as monitored by activity trackers. Analysis revealed no significant differences among the groups in leg extensor power, handgrip strength, or lean leg mass—all indicators exhibited declines across cohorts.

Notably, leg strength remained preserved at initial levels exclusively within the heavyweight resistance training group, whereas declines were observed in both moderate-intensity and comparison groups. This disparity, potentially linked to nervous system adaptations prompted by resistance training, attained statistical significance.

Conversely, visceral fat levels remained unchanged in the weights resistance training and moderate-intensity exercise groups yet notably increased in the comparison group—a finding suggesting that specific physiological parameters may exhibit differential responses to exercise modalities over prolonged periods.

Acknowledging that study participants skewed healthier and more physically active than the general population, despite prevalent chronic conditions affecting 80% of cases, researchers cautioned against generalising the findings broadly. Nonetheless, they concluded that the study furnishes compelling evidence supporting the enduring efficacy of heavy resistance training during retirement years.

The implications underscore potential strategies for healthcare practitioners and policymakers to promote and advocate for sustained engagement in rigorous resistance training among older adults. The study’s findings provide compelling evidence supporting the enduring efficacy of heavy resistance training during retirement years, inspiring us to advocate for this approach and foster enhanced health outcomes and functional independence in later life.

More information: Mads Bloch-Ibenfeldt et al, Heavy resistance training at retirement age induces 4-year lasting beneficial effects in muscle strength: a long-term follow-up of an RCT, BMJ Open Sport & Exercise Medicine. DOI: 10.1136/bmjsem-2024-001899

Journal information: BMJ Open Sport & Exercise Medicine Provided by BMJ Group

Subtle Cognitive Decline Signals End of Driving for Older Adults

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Navigating the decision to relinquish driving privileges poses a significant challenge for older adults. Recent research from Washington University School of Medicine in St. Louis sheds light on this complex issue, suggesting that cognitive decline, rather than age or Alzheimer’s disease markers, often signals the time to stop driving. The study underscores that even minor cognitive changes can indicate impending retirement from driving, with women more likely than men to make this decision.

Published in Neurology, the study advocates for regular cognitive assessments tailored to detect subtle declines early on. These assessments, crucial for informed decision-making, could help older adults and their physicians enhance safety while preserving independence. According to Ganesh M. Babulal, PhD, OTD, the study’s lead author, proactive discussions about cognitive changes are essential. Early identification of risks allows for interventions that support driving skills and facilitate a smoother transition to alternative transportation options when necessary.

Despite older adults over 65 being among the most cautious drivers, age-related factors such as slower reactions, impaired vision, and cognitive decline increase their crash risk. Moreover, older drivers are more likely to suffer severe consequences when accidents occur than younger counterparts. However, ceasing to drive isn’t without its challenges—those who stop driving face higher risks of depression and isolation.

The research, which lasted over 5.6 years and involved 283 participants initially free of cognitive impairments, monitored changes through cognitive tests, including the Clinical Dementia Rating (CDR) and the Preclinical Alzheimer’s Cognitive Composite (PACC) score. Surprisingly, neither age nor Alzheimer’s biomarkers strongly influenced the decision to stop driving. Instead, cognitive impairment and declining PACC scores emerged as key predictors, highlighting the importance of monitoring subtle cognitive changes.

Gender also played a significant role, with women showing a higher likelihood of stopping driving during the study period compared to men. This finding challenges stereotypes about driving abilities between genders and underscores the proactive approach women often take in acknowledging changes in their driving skills.

Dr Babulal emphasises the need for healthcare providers to initiate conversations about driving cessation early on. He advocates for tailored interventions, such as driver rehabilitation programmes led by occupational therapists, which equip older drivers with strategies to adapt to physical and cognitive changes. Community support programmes also play a crucial role in educating older adults about safe driving practices and alternative transport options.

While most older adults eventually need to stop driving, the study underscores the benefits of proactive planning and support in maintaining independence and quality of life. By integrating routine cognitive assessments and fostering open discussions, healthcare providers can be pivotal in ensuring older adults navigate this transition confidently and safely.

More information: Ganesh M. Babulal et al, Predicting Driving Cessation Among Cognitively Normal Older Drivers, Neurology. DOI: 10.1212/WNL.0000000000209426

Journal information: Neurology Provided by Washington University School of Medicine

Advanced Facial Screening Tool Rapidly Detects Stroke Risk in Seconds

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A groundbreaking smartphone facial screening tool has been developed to revolutionise stroke detection. It offers paramedics the ability to identify stroke risk within seconds, far surpassing current technologies in speed and accuracy.

Strokes, a widespread global health concern, occur when blood flow to the brain is disrupted, depriving brain tissue of essential oxygen and nutrients. The timely detection of strokes is crucial, as even a few minutes delay can lead to irreversible brain damage. Recognising this urgency, a team of biomedical engineers at RMIT University has pioneered AI-driven software capable of swiftly assessing stroke risk via facial analysis. Published in Computer Methods and Programs in Biomedicine, their research is spearheaded by PhD scholar Guilherme Camargo de Oliveira under the guidance of Professor Dinesh Kumar.

From RMIT’s School of Engineering, Professor Kumar underscores the tool’s potential impact: “Early stroke detection is critical for enhancing recovery outcomes, reducing disability, and saving lives. Our smartphone tool empowers paramedics to swiftly determine stroke likelihood on the spot, ensuring timely hospital notification before the patient even reaches the ambulance.”

The smartphone tool, boasting an impressive 82% accuracy rate in stroke detection, complements rather than replaces comprehensive clinical diagnostics. It primarily identifies individuals who urgently require treatment and streamlines emergency response protocols. This innovation addresses a significant gap in current emergency care, where up to 13% of strokes are reportedly missed, particularly among women, people of colour, and patients presenting subtle symptoms.

The technology’s use of AI-enabled facial expression recognition is central to its analysis of facial symmetry and muscle movements known as action units. Leveraging the Facial Action Coding System (FACS), initially developed in the 1970s, the tool detects asymmetry—a hallmark sign of stroke-induced facial muscle impairment. The researchers validated the tool’s effectiveness in real-world scenarios by examining video recordings of facial expressions from stroke patients and healthy controls.

Looking ahead, the team aims to expand the tool’s capabilities beyond stroke detection. Collaborating with healthcare providers, they plan to integrate the technology into a comprehensive app that identifies various neurological conditions affecting facial expressions. This evolution seeks to enhance sensitivity and specificity, broadening its utility in emergencies and potentially transforming how paramedics approach critical patient care.

“Integration into existing emergency response protocols is paramount,” Kumar emphasises. “By collaborating closely with healthcare providers, we aim to ensure seamless adoption of this tool, equipping paramedics with a powerful ally in early stroke detection and improving outcomes for patients worldwide.”

More information: Guilherme C. Oliveira et al, Facial expressions to identify post-stroke: A pilot study, Computer Methods and Programs in Biomedicine. DOI: 10.1016/j.cmpb.2024.108195

Journal information: Computer Methods and Programs in Biomedicine Provided by RMIT University

Study Finds Higher Healthcare Costs Linked to Unplanned Utilization Among Patients with Cognitive Impairment

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Researchers from Duke-NUS Medical School and the NUS Yong Loo Lin School of Medicine utilised population-based Singapore Chinese Health Study data. They discovered that individuals with cognitive impairment spend, on average, 17 per cent more per year on healthcare compared to peers without cognitive impairment of the same age. Published in the Annals of the Academy of Medicine Singapore, the study underscores that these increased costs primarily stem from emergency department visits and subsequent admissions.

Health economist Assistant Professor Chay Junxing, from the Lien Centre for Palliative Care at Duke-NUS, who led the study, emphasised the significance of these findings: “This study provides the first quantification of additional healthcare expenditures among patients with cognitive impairment in Singapore. Emergency department visits and subsequent admissions emerge as the major cost drivers. Armed with this knowledge, we can develop strategies to mitigate these admissions.”

In 2019, an estimated 44,000 individuals in Singapore were living with some form of cognitive impairment, a number expected to rise with the ageing population. The Ministry of Health projects that by 2030, the number of people with dementia alone could reach 152,000, increasing further to 187,000 by 2050. As observed by the researchers, these projections suggest additional healthcare spending of S$106 million and S$131 million during these years.

The study’s projections underscore the urgency for novel approaches to manage the escalating burden of unplanned healthcare utilisation. Recommendations from the authors include proactive monitoring of individuals with cognitive impairment to mitigate risk factors for high-cost medical events.

Senior author Professor Eric Finkelstein, Executive Director of the Lien Centre for Palliative Care at Duke-NUS, highlighted the impending strain on healthcare resources: “Rising rates of cognitive impairment, coupled with Singapore’s ageing population, foreshadow increased pressure on healthcare services. Planners must anticipate this exponential growth in burden, focusing efforts on identifying at-risk patients and intervening before crises arise.”

The researchers advocate for collaborative efforts with nursing homes and other care facilities to enhance care across the illness continuum, yielding health and economic benefits. The study also reveals that individuals with cognitive impairment frequently utilise emergency services. Previous research has identified common reasons for these visits, such as pneumonia, heart failure, urinary tract infections, and fall-related injuries. Factors contributing to heightened emergency service use include increased susceptibility to injuries and infections, lower treatment adherence, and challenges in post-discharge care continuity.

Professor Patrick Tan, Senior Vice-Dean for Research at Duke-NUS, underscored the study’s insights into healthcare service utilisation: “Understanding patterns of healthcare service use provides critical insights into delivering not only cost-effective care but also improving patients’ quality of life. These findings underscore the need for expanded services targeting early identification of individuals at risk of cognitive impairment and better education for caregivers to support proactive management.”

The study highlights the escalating healthcare costs associated with cognitive impairment in Singapore, mainly driven by unplanned healthcare utilisation. Addressing these challenges requires innovative strategies for early intervention, enhanced caregiver education, and collaborative care approaches across healthcare settings.

More information: Junxing Chay et al, Healthcare burden of cognitive impairment: Evidence from a Singapore Chinese health study, Annals of the Academy of Medicine Singapore. DOI: 10.47102/annals-acadmedsg.2023253

Journal information: Annals of the Academy of Medicine Singapore Provided by Duke-NUS Medical School