Universal design and accessibility: an approach of the influence of muscle strength loss in the risk of falls in the elderly

This study was conducted with older adults living in a long-stay institution in the city of Foz do Iguacu, Parana, Brazil with the objective of assessing the influence of muscle strength loss in the risk of falls. The sample consisted of 65 elderly who walk without the aid of support for locomotion, 37 women and 28 men, aged between 67 and 80 years. The risk of falls was assessed through the TUG test. To determine the handgrip strength, a hand dynamometer model Jamar ( was used, which provides the result in kg / force (kgf), being held only with the dominant hand. The results showed that in the last 12 months, only 32% of the elderly surveyed had no fall and the average handgrip strength was 24.32 ( 11.22 kgf; 40% had one fall and the average handgrip strength was 23.82 ( 10.18 kgf; 8% had two falls and the average handgrip strength was 19.48 ( 8.21 kgf and 20% had more than one fall and the average handgrip strength of 18.13 ( 7.33 Kgf., indicating that the force levels are statistically lower among elderly at high risk of falls (p> 0.05). It was concluded that the lower the force level, the greater the likelihood of falls. Thus, it is important to stress that due to the loss of muscle strength, all ergonomic hazards and architectural barriers must be removed so that older adults can perform their tasks more easily, with comfort and safety.     

Association between hand-grip strength and erectile dysfunction in older men

Abstract

Objectives: To evaluate the association between handgrip strength and erectile dysfunction (ED) in community-dwelling older men.

Methods: This cross-sectional study included 1771 participants of the Dong-gu Study. Handgrip strength was measured with a handheld dynamometer. ED was assessed with the Korean version of the International Index of Erectile Function (IIEF). ED was categorized as none to mild (IIEF-EF scores of 13–30) and moderate to severe (IIEF-EF scores of 0–12). Multivariable logistic regression was conducted with adjustment for potential confounders.

Results: The proportion of men with moderate to severe ED was 48.8%. The age-adjusted ED score increased with increasing quartile of handgrip strength (11.0, 12.4, 13.4, and 14.0 in the lowest, second, third, and highest quartiles, respectively). After adjustment for potential confounders, greater handgrip strength was associated with a lower risk of ED (odds ratio (OR): 0.82 per 5?kg; 95% confidence interval (CI): 0.74–0.90). In addition, a high level of moderate to vigorous physical activity was associated with a lower risk of ED (OR: 0.75; 95% CI: 0.61–0.93).

Conclusion: In this study, aging men with greater handgrip strength had a lower risk of ED. This result suggests that reduced physical functioning may contribute to ED.     

Testosterone is associated with age-related changes in bone health status,muscle strength and body composition in men

Objective: Variations in testosterone levels are associated with several outcomes of aging. The present study aimed to examine the relationship between age-related decline of testosterone levels and changes in bone health status, handgrip strength, body fat percentage and fat-free mass. Materials and methods: A total of 335 Malaysian Chinese and Malay men aged 40 years and above were recruited for this study. Their body compositions, calcaneal speed of sound and handgrip strength were measured and their blood was collected. Linear regression analysis was done to examine the relationship among age, testosterone levels and outcomes of aging. Results: The results indicated significant changes in all testosterone measurements, sex hormone binding globulin level, calcaneal speed of sound, handgrip strength, body fat percentage and fat-free mass with age (p < 0.05). Age-dependent decline in bioavailable and free testosterone levels were significantly associated with reduction in calcaneal speed of sound, fat-free mass and handgrip strength (p < 0.05). Age-dependent decline in the total testosterone level was significantly associated with an increase in body fat percentage among the elderly men (p < 0.05). Conclusion: Testosterone levels are associated with changes in outcome of aging such as bone health status, muscle strength and body composition, and the relationships are age-dependent.     

Mild thyroid hormone excess is associated with a decreased physical function in elderly men

Introduction: In the adult, subclinical hyperthyroidism (Shyper) may alter skeletal muscle mass and strength. However, whether these effects are present in elderly subjects is not known. We explored the relationship between mild hyperthyroidism and physical function in a population-based sample of older persons. Methods: In a cross-sectional analysis, calf muscle cross-sectional area (CMA), handgrip strength, nerve conduction velocity (NCV), and Short Physical Performance Battery (SPPB) scores were compared between 364 euthyroid (Eut) and 28 Shyper men as well as between 502 Eut and 39 Shyper women. In a longitudinal analysis, we evaluated the relationship between baseline plasma TSH, FT3 and FT4 and the 3-year change in SPPB score in 304 men and 409 women who were euthyroid at enrolment. Results: At the cross-sectional analysis, Shyper men, but not women, had a significantly (p?=?0.02) lower SPPB score than Eut controls, although with comparable CMA, grip strength and NCV, and were more likely to have poor physical performance (odds ratio?=?2.97, p?<?0.05). Longitudinal analysis showed that in Eut men higher baseline FT4 was significantly (p?=?0.02) predictive of a lower SPPB score at the 3-year follow-up. Conclusion: Even a modest thyroid hormone excess is associated with a reduced physical function in elderly men.     

Association between sarcopenia and erectile dysfunction in males with type II diabetes mellitus

Background: The prevalence rates for both sarcopenia and erectile dysfunction (ED) gradually increase in middle-aged and elderly diabetic male population and they impair physical functioning, sexual functioning, and quality of life. The aim of the present study was to evaluate the sarcopenia in patients with diabetic ED.

Methods: The study included 98 male patients with type II diabetes mellitus (DM) aged 18–80?years. Blood chemistry and hormone levels were obtained. The International Index of Erectile Function (IIEF-5) questionnaire was administered to the patients. The patients were divided into three groups according to the IIEF-5 score; a score of 5–10 points indicated severe ED, a score of 11–20 indicated moderate ED, and a score of 21–25 points indicated no ED. The muscle mass, handgrip strength, timed up and go test, upper mid-arm circumference, calf circumference, and body mass index were obtained. The statistical analysis was performed using MedCalc Statistical Software version 12.7.7. All parameters were compared between the three groups.

Results: Of 98 patients included in the study, 84 patients had severe sarcopenia, 13 had moderate sarcopenia, while only one patient had normal muscle mass. The mean age was 56.59?±?11.46?years. When patients were divided into three groups according to IIEF-5 score, 38 had severe ED, 39 had moderate ED, and 21 had no ED. There was a significant difference between the three groups in terms of handgrip strength, timed up and go test scores, upper mid-arm circumference, and calf circumference (p?Conclusions: Although muscle mass remains unchanged, muscle strength and physical performance decrease in diabetic ED patients. Diabetic patients with severe and moderate ED have lower muscle strength and physical performance.     

Relationship between a three-month physical conditioning “posture-balance-motricity and health education” (PBM-HE) program on postural and balance capacities of sedentary older adults: influence of initial motor profile

Background

The aims of this study were (i) to define the relationship between a physical reconditioning cycle using balance exercises and muscular-articular stress and the balance capabilities of sedentary older adults and (ii) to assess whether older adults with weaker equilibrium abilities have a significantly limited progression. Our sample consisted of 338 people (263 women, 75 men) with an age, weight and height of 74.4 years (+/??8.6), 67 kg (+/??13.6) and 161.4 cm (+/??8) and with a body mass index of 25.6 (+/??4.3). The functional evaluations consisted of individual motor profile tests, monopodal eyes open and eyes closed for 30 s, a Timed Up and Go test (TUG) and stabilometric measurements on hard ground with eyes open for a duration of 25.6 s. The physical repackaging protocol was based on the 12-week Posture-Balance-Motricity and Health Education (PBM-ES) method with two 90-min weekly group sessions.

Results

The evolution of the “posture” and “balance” variables was significantly associated with the equilibration capacities (p?<?0.001). For unipedal stance with open eyes on the dominant and non-dominant sides, respectively, the progressions were significant for the profiles of middle (OR: 4.78 and 2.42) and low levels (OR: 4.34 and 1.66). Eyes-closed progressions were non-significant for the low-level balance profiles. For the COP Surface and Length variables, compared to those with high levels of balance, respectively, the progressions were significant for the middle- (OR: 1.41 and 2.98) and low-level (OR: 2.91 and 3.28) profiles.

Conclusions

After a 3-month bi-weekly PBM-HE program, we observed that sedentary older adults with the lowest initial level of balance progressed significantly more than high-level individuals, but only for basic motor abilities. It turns out that even among the most deconditioned people and older adults, very significant progress can be made. This increase requires an individualized training content focused on initial mobilizable capacities.

     

Relation between hand grip strength,respiratory muscle strength and spirometric measures in male nursing home residents

Abstract

Adverse-outcomes related to sarcopenia are mostly mentioned as physical disability. As the other skeletal muscles, respiratory muscles may also be affected by sarcopenia. Respiratory muscle strength is known to affect pulmonary functions. Therefore, we aimed to investigate the relations between extremity muscle strength, respiratory muscle strengths and spirometric measures in a group of male nursing home residents. Among a total of 104 male residents, residents with obstructive measures were excluded and final study population was composed of 62 residents. Mean age was 70.5?±?6.7 years, body mass index: 27.7?±?5.3?kg/m² and dominant hand grip strength: 29.7?±?6.5?kg. Hand grip strength was positively correlated with maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) (r?=?0.35, p?<?0.01 and r?=?0.26, p?<?0.05, respectively). In regression analysis, the only factor related to MIP was hand grip strength; among spirometric measures only parameter significantly related to grip strength was peak cough flow (PCF). The association of PCF with grip strength disappeared when MIP alone or “MIP and MEP” were included in the regression analysis. In the latter case, PCF was significantly associated only with MIP. We found peripheric muscle strength be associated with MIP and PCF but not with MEP or any other spirometric parameters. The relation between peripheral muscle strength and PCF was mediated by MIP. Our findings suggest that sarcopenia may affect inspiratory muscle strength earlier or more than the expiratory muscle strength. Sarcopenia may cause decrease in PCF in the elderly, which may stand for some common adverse respiratory complications.     

The aging male in African ethnic cultures

Objective.?To test the relationship between gonadal status and objective measures and determinants of physical performance in older men and their determinants.

Methods.?The study included 455?≥?65 year older men of InCHIANTI study, Italy, with complete data on testosterone levels, hand grip strength, cross-sectional muscle area (CSMA), short physical performance battery (SPPB). Linear models were used to test the relationship between gonadal status and determinants of physical performance.

Results.?Three different groups of older men were created: (1) severely hypogonadal (N?=?23), total testosterone levels ≤230?ng /dl; (2) moderately hypogonadal (N?=?88), total testosterone >230 and?N?=?344), testosterone levels ≥350?ng/dl. With increased severity of hypogonadal status, participants were significantly older while their BMI was substantially similar. In the age and BMI adjusted analysis, there was a significant difference in haemoglobin levels, hand grip strength and SPPB score (p for trend?p for trend?=?0.004) and haemoglobin (p for trend?Conclusions.?In older men, gonadal status is independently associated with some determinants (haemoglobin and muscle strength) of physical performance.     

Low-intermediate dose testosterone replacement therapy by different pharmaceutical preparations improves frailty score in elderly hypogonadal hyperglycaemic patients

Abstract

An open-label follow-up study of low-to-intermediate dose testosterone replacement therapy (TRT) was conducted in 64 overweight patients (aged 65–75 years) with late onset hypogonadism (LOH) and increased fasting plasma glucose (FPG). Patients were subdivided into four treatment groups: oral testosterone (T) (T undecanoate, 80?mg/d), transmucosal T (60?mg/d), transdermal T (30?mg/d) or no treatment (control), and evaluated at 0 and 6 months. FPG, hemoglobin (Hb), prostate-specific antigen (PSA) and total T were measured and the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) index was calculated. Body mass index (BMI), waist circumference, fitness level (6-min walking test), Aging Males’ Symptoms (AMS) scale, handgrip strength and energy expenditure with physical activity (Minnesota questionnaire for Leisure Time Physical Activity (LTPA)) were evaluated and a “frailty score” (based on: grip strength, gait speed and LTPA) was calculated. T levels increased in all treatment groups; the oral T group had values still in the hypogonadal range (5.9?±?1.1?nmol/L). PSA and Hb concentrations did not change in any group. BMI, waist circumference, FPG and HOMA-IR improved in all T-treated groups after 6 months, with a greater effect seen with transmucosal and transdermal T compared with oral T. This study indicates that low-to-intermediate dose TRT may be safely utilized in LOH patients to ameliorate somatic and psychological frailty symptoms in association with improved anthropometric and glycometabolic parameters in aging, overweight men with LOH and impaired fasting glucose.     

Associations of physical exercise as a lifestyle habit with lean and fat body mass and handgrip strength and age in Asian men

Abstract

Background: We evaluated how the intensity of physical exercise as a lifestyle habit is associated with age, body composition and handgrip strength.

Methods: Total body composition was analyzed using DEXA. Exercise scores were derived from an administered questionnaire and the scoring was calculated using the Metabolic Equivalent of Task (MET). Handgrip strength was measured using a dynamometer.

Results: Age, independent of exercise intensity, was associated with declining lean mass, and handgrip strength and with increasing total body fat. A regular physical exercise regime of intensity greater than 1230 MET-min/week was associated with higher total lean mass and lean mass in the limbs, and handgrip strength and lower fat mass in the limbs.

Discussion: We have shown that age was associated with lower lean mass especially in the limbs and handgrip strength and higher total fat mass. Regular physical exercise as a lifestyle habit of any type and of sufficient intensity could help improve muscle strength in the limbs.     

Low glomerular filtration rate as an associated risk factor for sarcopenic muscle strength: is creatinine or cystatin C-based estimation more relevant?

Introduction: We aimed to evaluate the association of a decreased glomerular-filtration-rate (GFR?<60?ml/min/1.73?m²), estimated using Modification of Diet in Renal Disease (MDRD), creatinine- and cystatin C-based (CKDEPI-CR and CKDEPI-CC) Chronic Kidney Disease Epidemiology Collaboration equations with handgrip strength (HGS).

Methods: Community-dwelling males aged?≥60 years admitted to outpatient clinic were included. We used MDRD, CKDEPI-CR, and CKDEPI-CC formulas for GFR estimation and corrected these for body surface area. Muscle strength was assessed by HGS.

Results: 209 men (mean age 67.8?±?6.4) were enrolled. Sixty-two patients (29.7%) had sarcopenic HGS. Subjects with sarcopenic HGS were older, had higher rate of a GFR?2, had lower mid-upper arm circumference; tended to have lower creatine kinase, albumin, CKDEPI-CC-GFR levels; and higher BUN/creatinine ratio and cystatin C. Multivariate logistic regression analysis revealed a CKDEPI-CC lower than 60?ml/min/1.73 m² as the only independent factor underlying sarcopenic HGS. Higher age tended to have an independent association. Only higher age was independently associated with low HGS when other estimations were used (p?=?0.013 and p?=?0.021 when MDRD and CKDEPI-CR were used, respectively).

Conclusions: There is a strong association of a GFR level of <60?ml/min/1.73 m² with sarcopenic HGS, when CKDEPI-CC formula is used.     

The effects of sex steroids and some elements of lifestyle on the normal variation of bone mineral content in younger versus older healthy Polish males

The aim of the study was to evaluate the independent ‘net’ effects of hormonal variables (estradiol, free testosterone and dehydroepiandrosterone sulfate (DHEAS) levels) and lifestyle variables (alcohol consumption, coffee drinking, cigarette smoking, physical activity and muscle strength) on trabecular, cortical and total bone mineral content (BMC) in a group of 236 healthy males, aged 22–67 years. The men were occupationally active inhabitants of the city of Wroclaw, Lower Silesia, Poland. Trabecular, cortical and total bone mineral content, at the distal radius of the non-dominant hand, were assessed by peripheral quantitative computed tomography (pQCT) using the Stratec 960 apparatus. Sex steroids levels were measured using standard immunoassays. Data on lifestyle variables (alcohol consumption, cigarette smoking, coffee drinking and physical activity) were obtained through a questionnaire. Hand-grip strength of the dominant hand was assessed using a standard dynamometer. All statistical analyses were made separately in two subgroups, younger males (aged 22–39 years) and older males (aged 40 years and over). The impact of a particular independent variable on BMC and the extent of determination on BMC by the complex of chosen variables were evaluated using a path analysis. In younger males, the effects of physical activity and muscle strength were the most important among all the factors that influenced BMC, as they contributed to 16.2%, 16.9% and 16.5% of the variability of trabecular, cortical and total BMC, respectively. Taking into consideration cigarette smoking, alcohol and coffee drinking together, the coefficients of determination of the variability in trabecular, cortical and total BMC were 10.6%, 11.3% and 16.1%, respectively. The variances in trabecular, cortical and total BMC levels were determined in only 5.8%, 11.5% and 13.0% by sex steroids, respectively. The influence of free testosterone on trabecular BMC was greater compared with that of dehydroepiandrosterone sulfate (DHEAS) and estradiol; for cortical BMC, the impacts of estradiol and DHEAS were similar and greater than that of free testosterone, and the variability of total BMC was affected mainly by estradiol. In contrast, in older men the effects of physical activity and muscular strength were the least important among all the complexes of independent variables, as they contributed to 4.5%, 7.8% and 7.0% of the variability in trabecular, cortical and total BMC, respectively. Taking into consideration the influences of cigarette smoking, alcohol and coffee drinking, the coefficients of determination of the variability in trabecular, cortical and total BMC were 16.5%, 14.8% and 17.4%, respectively. Among the older men, the variances in trabecular, cortical and total BMC were determined in only 9.4%, 6.3% and 13.6% by sex steroid levels, respectively. The influence of DHEAS on trabecular BMC was greater when compared with that of estradiol and free testosterone, whereas the variability of both cortical and total BMC in older men was affected mainly by estradiol. It is quite striking that, in younger healthy subjects, both physical activity and muscle strength contributed to a greater extent to BMC variance when compared with sex steroids levels, whereas, in older men, physical activity and muscular strength were less important than androgen- estrogen activity in determining the variability of BMC. This may suggest that the tropic effect of mechanical force influences bone structure mainly in younger men; probably male bone tissue becomes less prone to mechanical stimuli during aging. It is astonishing that both in younger and older men the coefficients of determination of physical activity and muscle strength were the highest for cortical BMC, which would indicate the greatest response of that part of the bone tissue to mechanical force. It is worth noting that the coefficients of determination of the complex of lifestyle factors (alcohol consumption, cigarette smoking and coffee drinking) were higher in older men compared to younger Polish males. This can be explained by the longer exposure of male bone to environmental influences (ethanol, nicotine, caffeine) during a lifetime. Our study revealed that all the evaluated variables were related to the variability in BMC in healthy Polish men, but the coefficients of determination differed depending on the age of the examined subject and on the BMC of a particular bone component. This suggests that the responsiveness of male bone tissue to environmental factors changes with age, and that these effects vary significantly between particular parts of the male bone structure.     

Elevated high sensitivity C-reactive protein levels in aging men with low testosterone

Objective.?We examined baseline data from a lipid treatment study to assess the relationship between testosterone (T) and the cardiovascular inflammatory marker, high sensitivity C-reactive protein (hsCRP).

Methods.?The baseline T, hsCRP, lipid, glycemic, and anthropometric data were obtained from 467 men (mean age: 52 years). Inclusion criteria included low-density lipoprotein cholesterol ≥?3.4 to 4.9?mmol/l and triglycerides?≤?4.0?mmol/l. The baseline hsCRP levels were examined across the following T subgroups: <6.9?nmol/l (moderate to severe hypogonadism), 6.9 to <10.4?nmol/l (mild to moderate hypogonadism), 10.4 to <15?nmol/l (low-normal T), and?≥?15?nmol/l (normal T).

Results.?The median hsCRP levels were significantly (p?=?0.041) different across the four T subgroups; patients in the lower T subgroups had higher median hsCRP levels than patients in the higher T subgroups. The percentage of men with elevated hsCRP (>2?mg/l) was also significantly (p?=?0.038) different across the four T subgroups; 83% of men with T < 6.9?nmol/l had elevated hsCRP compared with 40% with T ≥ 15?nmol/l.

Conclusions.?This analysis demonstrated an inverse relationship between serum T and hsCRP in aging men. Urologists need to be aware that low T levels may not only adversely affect sexual function but also may worsen cardiovascular risk in aging, hypogonadal men.     

National and Local Attachments in a Changing World System: Evidence from an International Survey Revised version of a paper prepared for presentation in the Session on ‘Belongingness,Values and Territoriality’, Biennial Congress of the International Institute of Sociology,Cracow, Poland,July 2001.

Attachment to community is a central component of identities in the modern world, and community attachment can be expressed at different levels within national states. Most classical perspectives on modern societies have taken for granted that national states have long been the most important locus of citizen attachment and loyalty in the contemporary world system. More recently, many influential perspectives on globalization have suggested that national states are becoming less important, because of the rise of subnational units on the one hand, and supranational entities on the other. What is the relative importance of national, subnational, local, and supranational attachments in the contemporary world system? Is the structure of attitudes similar across national settings? What is the relative strength of attachment to the nation versus attachment to other levels of community? How willing are people to move to a different community to improve their economic condition? This exploratory paper will investigate these questions by examining the 1995 International Social Survey Programme (ISSP) data on national identities in 24 countries.     

Total testosterone levels are correlated to metabolic syndrome components

Introduction: Metabolic syndrome (MetS) is a constellation of interrelated risk factors of metabolic origin. Some studies suggest a possible link between low total testosterone (TT) levels and the presence of MetS.

Aim: To analyze the strength and independence of associations between TT and MetS components in non-diabetic men.

Methods: In this cross-sectional study, 143 non-diabetic men older than 40 were analyzed.

Main outcomes measure: Blood samples were collected to evaluate metabolic profile and TT levels. MetS was defined as the presence of three or more of the following characteristics: fasting blood glucose levels?≥?100?mg/dL, triglyceride?≥?150?mg/dL, HDL-c??102?cm.

Results: Mean age of the study population was 61.5?±?8.61 years old. MetS was present in 47.9% of the individuals. Thirty-four men had low TT and MetS was observed in 23 (70%) against 50 (46%) in those with normal TT (≥?300?ng/dL) (OR 4.94, p?p?=?0.03) and HDL-c (Beta: 0.19; p?=?0.04) remained significantly correlated with TT levels.

Conclusions: Low TT levels were associated with MetS diagnosis. Abdominal obesity was the MetS component independently correlated to low TT levels.     

Association between serum levels of testosterone and biomarkers of subclinical atherosclerosis

Objective: To investigate the association between serum levels of testosterone and biomarkers of subclinical atherosclerosis based on data from 119 middle-aged men of the general population.

Methods: Testosterone, Apolipoprotein A-1 (ApoA-1), Apolipoprotein B (ApoB), Apolipoprotein B-to-Apolipoprotein A-1 ratio (ApoB-to-ApoA-1), high-sensitive C-reactive protein (hsCRP), and fibrinogen levels were measured. Data were also gathered based on age, BMI, waist circumference, smoking, alcohol consumption, and family history of cardiovascular diseases. Men were classified into two groups based on testosterone levels: hypogonadal (testosterone ≤12?nmol/L) and eugonadal men (testosterone >12?nmol/L).

Results: When compared to eugonadal, the hypogonadal men were significantly older (56?years vs. 55?years, p?=?.03), had greater BMI (28?kg/cm² vs. 26?kg/cm², p?=?.01), and higher waist circumference (104?cm vs. 100?cm, p?=?.01). Moreover, ApoB, ApoB-to-ApoA-1 ratio, and hsCRP were significantly higher in hypogonadal men compared to eugonadal men (1.1?g/L vs. 1.0?g/L, p?=?.03), (0.8 vs. 0.7, p?=?.03), (3.3?mg/L vs. 2.0?mg/L, p?=?.01), respectively. On the other hand, ApoA-1 and fibrinogen levels did not differ significantly between groups (p?>?.05). In an adjusted multivariate regression analysis model, only ApoB showed a significant negative association with testosterone levels (β?=??0.01; 95% CI?=??0.02, ?1.50; p?=?.04).

Conclusion: Testosterone levels showed an inverse relation to ApoB, a biomarker implicated in subclinical atherosclerosis. These findings support the hypothesis that low testosterone levels play a role in atherosclerosis.     

Development of a carpal tunnel syndrome screening method using structured interviews and vibrotactile testing

Carpal tunnel syndrome (CTS) is a debilitating and expensive health problem. An inexpensive screening method that would differentiate between people who do not have CTS and those that may have CTS would be useful. The screening methodology investigated here had two phases: a structured interview and provocative vibrotactile testing (VT). The control group (n = 36) was composed of asymptomatic college students and faculty, the case group was composed of patients currently visiting an occupational medicine clinic for symptoms consistent with CTS. The case group was subdivided into positive and negative for nerve conduction latency, NCL+ (n = 21) and NCL- (n = 13), respectively. Using a scored, structured interview, 33 of the controls and none of the symptomatic cases were identified as non-CTS. The results from the provocative flexion VT indicated that if the difference between the age corrected baseline and the threshold at 15 minutes is 15 microm or more, the subject was likely to be NCL+ (odds ratio 12.6, 95% CI 3.8 to 41.8). Further research may improve this screening methodology to not only determine whether or not a person has CTS, but also to determine the level of median nerve impingement or damage.     

Cognitive impairment and effects on upper body strength of adults with dementia

The purpose of this investigation was to examine the association between cognitive ability and upper body muscle strength. Two sources of existing data were pooled for this examination. Thirty-eight older participants diagnosed with Alzheimer's disease or dementia (25 women, 13 men; age = 83.2 +/- 5.6 years, MMSE score = 16.75 +/- 7.04, M +/- SD) underwent an assessment of grip strength via handheld dynamometry. Multiple-regression analysis indicated that cognitive status was a significant predictor of strength and, when combined in a model with age and sex, explained 57% of the between-individuals variance in handgrip strength. The findings from this exploratory investigation suggest that dementia is associated with strength loss, a key contributor to functional disability; this further justifies efforts to investigate mechanisms responsible for this decay and to preserve muscle integrity by integrating physical activity interventions, notably, muscle strengthening, into the lifestyle of adults with dementia.     

Accessibility of sports facilities for persons with reduced mobility and assessment of their motivation for practice

This study aims to create awareness, both within the scientific community and among providers of sports facilities, for individuals with impaired or reduced mobility, promoting the development of technical solutions that allow greater autonomy and social integration of people with disabilities. The purpose of this work is, on the one hand, to evaluate the accessibility of sports facilities for people with reduced mobility and, on the other hand, to investigate why this user group has such low rates of participation in sporting activities. Firstly, using the Portuguese norms and legislation transcribed from European Community directives, a check list was created comprising all the items that sports facilities should abide by in order to provide accessibility and safety to people with reduced mobility. Another questionnaire was designed aimed at this user group, with questions pertaining to their desire and ability to use sports facilities. This questionnaire was distributed in Portugal, in the greater metropolitan area of Porto, to users of Rehabilitation Centres and Physiotherapy Clinics. The results obtained from the check-list showed the compliances and non-compliances of the respective sports facilities, proving that many barriers preventing the participation of people with reduced mobility still exist. Twenty-four people with permanent impairment of the lower extremities (paraplegia) answered the questionnaire pertaining to the desire and ability to perform physical activity. Two individuals (8%) had sporting activities available to them in their area of residence and only five (21%) performed any physical activity. The main reason given for not taking part in any activity was the lack of adapted sports facilities. All the participants felt that taking part in sports is beneficial. The benefits stated were: general well-being and development of the psychomotor component (e.g. coordination, balance, body posture), of physical condition (e.g. strength, resistance, flexibility) and social integration and quality of life. Besides wellbeing, they also mentioned social interaction, a way of occupying their time and an escape from the routine as the main motives for which they would like to take up physical exercise.