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Functional performance, nutritional status, and body composition in ambulant community-dwelling individuals 1-3 years after suffering from a cerebral infarction or intracerebral bleeding
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy. (Karin Hellström)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
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2016 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 16, 48Article in journal (Refereed) Published
Abstract [en]

Background:Muscle wasting and obesity may complicate the post-stroke trajectory. We investigated the relationshipsbetween nutritional status, body composition, and mobility one to 3 years after stroke.

Methods:Among 279 eligible home-dwelling individuals who had suffered a stroke (except for subarachnoidbleeding) 1–3 years earlier, 134 (74 ± 5 years, 69 % men) were examined according to the Mini NutritionalAssessment-Short Form (MNA-SF, 0–14 points), including body mass index (BMI, kg/m2), body composition bybio-impedance analyses (Tanita BC-545), the Short Physical Performance Battery (SPPB, 0–12 points) combiningwalking speed, balance, and chair stand capacity, and the self-reported Physical Activity Scale for the Elderly (PASE).

Results:BMI≥30 kg/m2was observed in 22 % of cases, and 14 % were at risk for malnutrition according to theMNA-SF. SPPB scores≤8 in 28 % of cases indicated high risk for disability. Mobility based on the SPPB was notassociated with the fat-free mass index (FFMI) or fat mass index (FMI). Multivariate logistic regression indicatedthat low mobility, i.e., SPPB≤8 points, was independently related to risk for malnutrition (OR 4.3, CI 1.7–10.5,P= 0.02), low physical activity (PASE) (OR 6.5, CI 2.0–21.2,P= 0.02), and high age (OR 0.36, CI 0.15–0.85,P= 0.02).Sarcopenia, defined as a reduced FFMI combined with SPPB scores≤8 or reduced gait speed (<1 m/s), was observedin 7 % of cases. None of the individuals displayed sarcopenic obesity (SO), defined as sarcopenia with BMI > 30 kg/m2.

Conclusions:Nutritional disorders, i.e., obesity, sarcopenia, or risk for malnutrition, were observed in about one-thirdof individuals 1 year after stroke. Risk for malnutrition, self-reported physical activity, and age were related to mobility(SPPB), whereas fat-free mass (FFM) and fat mass (FM) were not. Nutrition and exercise treatment could be furtherevaluated as rehabilitation opportunities after stroke

Place, publisher, year, edition, pages
2016. Vol. 16, 48
Keyword [en]
mobility limitations, stroke, sarcopenia, muscle atrophy, sarcopen obesitas, physical activity, obesity, malnutrition, aging
National Category
Medical and Health Sciences
Research subject
Geriatrics; Nutrition
Identifiers
URN: urn:nbn:se:uu:diva-236911DOI: 10.1186/s12877-016-0226-1ISI: 000370483600001PubMedID: 26895855OAI: oai:DiVA.org:uu-236911DiVA: diva2:765935
Note

Title in Thesis list of papers: Body Composition, Nutritional Status, and Physical Function in Community-Living Individuals 1-2 Years after Suffering a Stroke

Available from: 2014-11-25 Created: 2014-11-25 Last updated: 2017-12-05Bibliographically approved
In thesis
1. Physical Functioning, Body Composition and Exercise in Elderly Community-living Individuals with Stroke
Open this publication in new window or tab >>Physical Functioning, Body Composition and Exercise in Elderly Community-living Individuals with Stroke
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

A comprehensive view of physical function, body composition and exercise post-stroke that is based on clinical examination is lacking. The effects of a progressive resistance and balance (PRB) exercise program have not been fully evaluated in community-living individuals after stroke.

The overall aim of this thesis was to explore and describe physical function, physical activity, body composition, nutritional status and psychological factors. Another aim was to evaluate both the short-term and long-term effects of a PRB exercise program.

Physical function, physical activity, body composition, nutritional status and psychological factors were assessed in community-living individuals (65-85 years) approximately 1 year after stroke. Paper I-II (n=195, n=134) had a cross-sectional design and the main outcome was mobility and physical activity. In paper III-IV, (n=67, n=43) individuals were randomly assigned to either a PRB exercise program group or a control group. The main outcomes were balance, mobility, fat-free mass (FFM) and fat-mass (FM).

In paper I, mobility was reduced and physical activity level was low compared to age-matched healthy controls. Factors explaining the variance in mobility were age, physical activity, fall-related self-efficacy and EQ-5D. In paper II, >20% had a BMI ≥30 kg/m2 and had an altered body composition that was mainly characterised by a high fat-mass index (FMI). Neither fat-free nor FM were associated with mobility in this cohort. The factors associated with low mobility were low physical activity Odds ratio (OR) (CI 95%) 8.2 (2.8-24.2), risk for malnutrition, OR 5.8 (1.6-21.1), and each 10-year period, OR 2.8 (1.24-6.24). Individuals participating in the PRB exercise program (paper III, n=67) revealed significantly higher balance, walking capacity and comfortable walking speed compared to the control group at 3 months. The faster walking speed persisted at 6 and 15 months. In paper IV (n=43), at 3 months, the PRB exercise group had a significant reduction in FM percentage and a decrease in IGF-1 compared with the control group. Further, changes in FMI were associated with improved walking capacity.

Many individuals perceived partly modifiable disabilities 1 year after stroke. Exercising in groups for 3 months improved physical function and decreased fat-mass percentage and IGF-1.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. 81 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1058
National Category
Medical and Health Sciences
Research subject
Geriatrics; Neurology; Nutrition
Identifiers
urn:nbn:se:uu:diva-236899 (URN)978-91-554-9120-8 (ISBN)
Public defence
2015-01-23, Gunne-salen, Ingång 10, Akademiska sjukhuset, Uppsala, 09:00 (English)
Opponent
Supervisors
Available from: 2014-12-18 Created: 2014-11-25 Last updated: 2015-02-03

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Vahlberg, BirgitZetterberg, LenaLindmark, BirgittaHellström, KarinCederholm, Tommy

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