Jor'dan A J, Jacob M E, Leritz E, Bean J F
Azizah J. Jor'dan, PhD, Instructor of Psychiatry, New England GRECC, 150 South Huntington Ave, Boston, MA 02130, Tel: 857-364-6339 Fax: 857-364-5368, E-mail:
J Frailty Aging. 2020;9(1):30-36. doi: 10.14283/jfa.2019.42.
The mobility of older adults is limited by the compounding effects of vascular health conditions, or vascular risk burden. However, little is known about the role of neuromuscular attributes among those in which vascular risk burden contributes to mobility limitations.
We investigated (1) the relationship between the absence/presence of type 2 diabetes, hypertension, and/or obesity and mobility measures and neuromuscular attributes, and (2) whether the association between vascular risk burden and mobility is mediated by lower limb neuromuscular attributes.
Cross-sectional analysis of baseline data from 430 older adults within the Boston RISE Study.
Measures of mobility were the Short Physical Performance Battery, habitual gait speed, and functional mobility as measured by the Late Life Function Instrument. We also evaluated lower limb neuromuscular attributes, namely leg strength, leg velocity, trunk extensor muscle endurance, knee and ankle range of motion, and sensory loss.
Participants self-reported the presence of None (n=93), One (n=179), Two (n=114), or Three (n=44) of the following conditions: diabetes, hypertension, and obesity. Multivariable regression models indicated that those with a greater vascular risk burden had worse performance on the Short Physical Performance Battery (p=0.01), slower gait speed (p=0.0003) and lower Basic and Advanced Late Life Function Instrument scores (p<0.003). These associations were independent of multiple covariates. Vascular risk burden was also found to be negatively associated with leg strength (p=0.0002) and knee flexion range of motion (p<0.0001) and an associated non-significant trend was observed with leg velocity (p=0.06). In addition, the association between vascular risk burden and mobility outcomes were found to be partially mediated by leg strength, leg velocity, and knee flexion range of motion.
Among older adults with vascular risk burden and mobility problems, neuromuscular impairments in attributes such as leg strength, leg velocity, and knee range of motion may need to be treatment priorities.
老年人的活动能力受到血管健康状况或血管风险负担的综合影响而受限。然而，对于血管风险负担导致活动能力受限的人群中神经肌肉属性的作用，我们知之甚少。
我们研究了（1）2型糖尿病、高血压和/或肥胖的有无与活动能力指标及神经肌肉属性之间的关系，以及（2）血管风险负担与活动能力之间的关联是否由下肢神经肌肉属性介导。
对波士顿RISE研究中430名老年人的基线数据进行横断面分析。
活动能力的测量指标包括简短体能状况量表、习惯性步速以及由晚年功能量表测量的功能性活动能力。我们还评估了下肢神经肌肉属性，即腿部力量、腿部速度、躯干伸肌耐力、膝关节和踝关节活动范围以及感觉丧失。
参与者自我报告存在以下情况的数量分别为：无（n = 93）、一种（n = 179）、两种（n = 114）或三种（n = 44）：糖尿病、高血压和肥胖。多变量回归模型表明，血管风险负担较重的人在简短体能状况量表上的表现较差（p = 0.01），步速较慢（p = 0.0003），并且在晚年功能量表的基础和高级评分上较低（p < 0.003）。这些关联独立于多个协变量。还发现血管风险负担与腿部力量（p = 0.0002）和膝关节屈曲活动范围（p < 0.0001）呈负相关，并且观察到与腿部速度存在相关但不显著的趋势（p = 0.06）。此外，发现血管风险负担与活动能力结果之间的关联部分由腿部力量、腿部速度和膝关节屈曲活动范围介导。
在有血管风险负担和活动能力问题的老年人中，腿部力量、腿部速度和膝关节活动范围等属性的神经肌肉损伤可能需要作为治疗重点。
