BUSCADOR RECOLECTA

El síndrome de la fragilidad define a los ancianos
vulnerables que tienen un riesgo elevado de sufrir
eventos adversos. Su fisiopatología y etiopatogenia es
compleja, pero actualmente disponemos de medidas
sencillas de capacidad funcional para su evaluación. La
inactividad física, que frecuentemente asocia el envejecimiento,
es uno de los factores fundamentales que
contribuye a la aparición de sarcopenia, aspecto central
de la fragilidad. Los programas de ejercicio físico
multicomponente y, particularmente el entrenamiento
de la fuerza, constituyen las intervenciones más eficaces
para retrasar la discapacidad y otros eventos adversos.
Así mismo, han demostrado su utilidad en otros
dominios frecuentemente asociados a este síndrome
como las caídas, el deterioro cognitivo y la depresión.
Sin embargo, es necesario investigar cuáles son los
componentes óptimos de un programa de fuerza en el
frágil, así como la óptima relación dosis-respuesta que
permita desarrollar guías clínicas específicas de actividad
física para este grupo poblacional., Frailty is a state of vulnerability that involves an increased risk of adverse events in older adults. It is a condition with a complex etiology and pathophysiology. At present, there are functional tools for its assessment that are simple and reliable. Physical inactivity is a major risk factor for sarcopenia, a core aspect of frailty. Currently, mulicomponent exercise programs, and especially resistance exercise, are the most relevant interventions to slow down disability and other adverse outcomes. Moreover, these programs are valuable interventions in other frailty domains such as falls, cognitive decline and depression. However, in frail aged patients it is necessary to explore optimal resistance training components and develop specific clinical guides of physical activity for this target population., Este trabajo se ha realizado en parte gracias a los proyectos de investigación
del Ministerio de Salud, Instituto de Salud
Carlos III, Departamento de Salud del Gobierno
de Navarra, Consejo Superior de
Deportes y Ministerio de Economía y Competitividad
I+D+I (2008-2011) del de España
(RD06/013/1003 and 87/2010, 008/EPB10/11
y DEP2011-24105), respectivamente.

Aging is associated with declines in the neuromuscular and cardiovascular systems, resulting in an impaired capacity to perform daily activities. Frailty is an age-associated biological syndrome characterized by decreases in the biological functional reserve and resistance to stressors due to changes in several physiological systems, which puts older individuals at special risk of disability. To counteract the neuromuscular and cardiovascular declines associated with aging, as well as to prevent and treat the frailty syndrome, the strength and endurance training seems to be an effective strategy to improve muscle hypertrophy, strength and power output, as well as endurance performance. The first purpose of this review was discuss the neuromuscular adaptations to strength training, as well as the cardiovascular adaptations to endurance training in healthy and frail elderly subjects. In addition, the second purpose of this study was investigate the concurrent training adaptations in the elderly. Based on the results found, the combination of strength and endurance training (i.e., concurrent training) performed at moderate volume and moderate to high intensity in elderly populations is the most effective way to improve both neuromuscular and cardiorespiratory functions. Moreover, exercise interventions that include muscle power training should be prescribed to frail elderly in order to improve the overall physical status of this population and prevent disability., This study was partially supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) of Brazil. This work was also supported in part by the Spanish Department of Health and Institute Carlos III of the Government of Spain [Spanish Net on Aging and frailty; (RETICEF)], Economy and Competitivity Department of the Government of Spain, under grants numbered RD12/043/0002, and DEP2011-24105, respectively. This project is also funded in part by the European Commision (FP7 Health, Project reference: 278803).

Background: A growing interest in frailty syndrome exists because it is regarded as a major predictor of
co-morbidities and mortality in older populations. Nevertheless, frailty assessment has been controversial,
particularly when identifying this syndrome in a community setting. Performance tests such as the 30-second chair
stand test (30-s CST) are a cornerstone for detecting early declines in functional independence. Additionally, recent
advances in body-fixed sensors have enhanced the sensors’ ability to automatically and accurately evaluate
kinematic parameters related to a specific movement performance. The purpose of this study is to use this new
technology to obtain kinematic parameters that can identify frailty in an aged population through the performance
the 30-s CST.
Methods: Eighteen adults with a mean age of 54 years, as well as sixteen pre-frail and thirteen frail patients with
mean ages of 78 and 85 years, respectively, performed the 30-s CST while threir trunk movements were measured
by a sensor-unit at vertebra L3. Sit-stand-sit cycles were determined using both acceleration and orientation
information to detect failed attempts. Movement-related phases (i.e. impulse, stand-up, and sit-down) were
differentiated based on seat off and seat on events. Finally, the kinematic parameters of the impulse, stand-up and
sit-down phases were obtained to identify potential differences across the three frailty groups.
Results: For the stand-up and sit-down phases, velocity peaks and “modified impulse” parameters clearly
differentiated subjects with different frailty levels (p < 0.001). The trunk orientation range during the impulse phase
was also able to classify a subject according to his frail syndrome (p < 0.001). Furthermore, these parameters derived
from the inertial units (IUs) are sensitive enough to detect frailty differences not registered by the number of
completed cycles which is the standard test outcome.
Conclusions: This study shows that IUs can enhance the information gained from tests currently used in clinical
practice, such as the 30-s CST. Parameters such as velocity peaks, impulse, and orientation range are able to
differentiate between adults and older populations with different frailty levels. This study indicates that early frailty
detection could be possible in clinical environments, and the subsequent interventions to correct these disabilities
could be prescribed before further degradation occurs., The authors are indebted to the Spanish Department of Health and Institute
Carlos III of the Government of Spain [Spanish Net on Aging and frailty;
(RETICEF)], Department of Health of the Government of Navarre and
Economy and Competitivity Department of the Government of Spain, for
financing this research with grants numbered RD12/0043/0022, 87/2010, and
DEP2011-24105 respectively.

Background: Total hip arthroplasty is a successful surgical treatment in patients with osteoarthritis of the hip.
Different questionnaires are used by the clinicians to assess functional capacity and the patient's pain, despite these
questionnaires are known to be subjective. Furthermore, many studies agree that kinematic and kinetic parameters
are crucial to evaluate and to provide useful information about the patient’s evolution for clinicians and
rehabilitation specialists. However, these quantities can currently only be obtained in a fully equipped gait
laboratory. Instrumented shoes can quantify gait velocity, kinetic, kinematic and symmetry parameters. The aim of
this study was to investigate whether the instrumented shoes is a sufficiently sensitive instrument to show
differences in mobility performance before and after total hip arthroplasty.
Methods: In this study, patients undergoing total hip arthroplasty were measured before and 6–8 months after
total hip arthroplasty. Both measurement sessions include 2 functional mobility tasks while the subject was wearing
instrumented shoes. Before each measurement the Harris Hip Score and the Traditional Western Ontario and
McMaster Universities osteoarthritis index were administered as well.
Results: The stance time and the average vertical ground reaction force measured with the instrumented shoes
during walking, and their symmetry index, showed significant differences before and after total hip arthroplasty.
However, the data obtained with the sit to stand test did not reveal this improvement after surgery.
Conclusions: Our results show that inter-limb asymmetry during a walking activity can be evaluated with the
instrumented shoes before and after total hip arthroplasty in an outpatient clinical setting., The first author gratefully acknowledges the Spanish Department of Health and
Institute Carlos III of the Government of Spain [Spanish Net on Aging and frailty;
(RETICEF)], and Economy and Competitivity Department of the Government of
Spain, under grants numbered RD12/043/0002 and DEP2011-24105, respectively,
for financing this research.

Background: We studied the influence of the ACE I/D and ACTN3 R577X polymorphisms (single or combined) on
lower-extremity function in older women in response to high-speed power training.
Methods: One hundred and thirty-nine healthy older Caucasian women participated in this study (age: 65.5 ± 8.2 years,
body mass: 67.0 ± 10.0 kg and height: 1.57 ± 0.06 m). Walking speed (S10) performance and functional capacity
assessed by the “get-up and go” (GUG) mobility test were measured at baseline (T1) and after a consecutive 12-week
period of high-speed power training (40-75% of one repetition maximum in arm and leg extensor exercises; 3 sets
4–12 reps, and two power exercises for upper and lower extremity). Genomic DNA was extracted from blood samples,
and genotyping analyses were performed by PCR methods. Genotype distributions between groups were compared
by Chi-Square test and the gains in physical performance were analyzed by two-way, repeated-measures ANOVA.
Results: There were no significant differences between genotype groups in men or women for adjusted baseline
phenotypes (P > 0.05). ACE I/D and ACTN3 polymorphisms showed a significant interaction genotype-training only in
S10 (P = 0.012 and P = 0.044, respectively) and not in the GUG test (P = 0.311 and P = 0.477, respectively). Analyses of
the combined effects between genotypes showed no other significant differences in all phenotypes (P < 0.05) at
baseline. However, in response to high-speed power training, a significant interaction on walking speed (P = 0.048)
was observed between the “power” (ACTN3 RR + RX & ACE DD) versus “non-power” muscularity-oriented genotypes
(ACTN3 XX & ACE II + ID)].
Conclusions: Thus, ACE I/D and ACTN3 R577X polymorphisms are likely candidates in the modulation of
exercise-related gait speed phenotype in older women but not a significant influence in mobility traits., The study was developed with the aid of a research fellowship, reference
number SFRH/BD/47114/2008, funded by POPH – QREN, shared by the
European Social Fund and the national funds of MCTES. This work was
supported in part by the Spanish Department of Health and Institute Carlos
III of the Government of Spain [Spanish Net on Aging and frailty; (RETICEF)]
and Economy and Competitivity Department of the Government of Spain,
under grants numbered RD12/043/0002, and DEP2011-24105, respectively.

Background: Physical frailty has become the center of attention of basic, clinical and demographic research due to
its incidence level and gravity of adverse outcomes with age. Frailty syndrome is estimated to affect 20 % of the
population older than 75 years. Thus, one of the greatest current challenges in this field is to identify parameters
that can discriminate between vulnerable and robust subjects. Gait analysis has been widely used to predict frailty.
The aim of the present study was to investigate whether a collection of parameters extracted from the trunk
acceleration signals could provide additional accurate information about frailty syndrome.
Methods: A total of 718 subjects from an elderly population (319 males, 399 females; age: 75.4 ± 6.1 years, mass:
71.8 ± 12.4 kg, height: 158 ± 6 cm) volunteered to participate in this study. The subjects completed a 3-m walk test
at their own gait velocity. Kinematic data were acquired from a tri-axial inertial orientation tracker.
Findings: The spatio-temporal and frequency parameters measured in this study with an inertial sensor are related
to gait disorders and showed significant differences among groups (frail, pre-frail and robust). A selection of those
parameters improves frailty classification obtained to gait velocity, compared to classification model based on gait
velocity solely.
Interpretation: Gait parameters simultaneously used with gait velocity are able to provide useful information for a
more accurate frailty classification. Moreover, this technique could improve the early detection of pre-frail status,
allowing clinicians to perform measurements outside of a laboratory environment with the potential to prescribe a
treatment for reversing their physical decline., This work was supported in part by the Spanish Department of Health and
Institute Carlos III of the Government of Spain [Spanish Net on Aging and
frailty; (RETICEF)], and Economy and Competitivity Department of the
Government of Spain, under grants numbered RD12/043/0002, and
DEP2011-24105, respectively.