abstract: The purpose of this study was to investigate the Feasibility of Using a Non-Counter Movement Squat to Assess Lower Body Strength in Adults ages 20-70 years. Feasibility was tested by measuring five feasibility metrics described by Bowen et al. (Bowen et al., 2009): Acceptability, Demand, Implementation, Practicality, and Limited Efficacy. Seven male subjects and fifteen female subjects participated in the study. The subjects had their height, weight, body fat percentage by bioelectrical impedance analysis (BIA), and grip strength measured. Subjects performed a warm-up on a cycle ergometer, a Non-Counter Movement Squat Test (NCMST) 1-repetition maximal strength test using a Smith machine, and a cool down on a treadmill. Each subject then completed a post-participation questionnaire used to measure acceptability, Demand was measured by subjects who agreed to participate, implementation was measured by subjects who completed the protocol, practicality was measured by an administrator survey, and limited efficacy was measured by distribution of strength results by age and for all subjects by sex. Results showed acceptance of hypotheses of acceptability, demand, implementation and practicality for both males and females. Limited efficacy was inconclusive for both males and females resulting in rejection of hypothesis. The findings of this study show that further research is needed to compare the NCMST to other lower body muscular strength tests to determine the validity of the NCMST. / Dissertation/Thesis / Masters Thesis Healthcare Innovation 2019

Originalmente, o termo sarcopenia foi definido como a diminuição da massa muscular relacionada ao envelhecimento. Ao longo da última década, tornou-se um termo mais abrangente reunindo a redução da força muscular (dinapenia) à redução da massa muscular. Em 2010, o European Working Group on Sarcopenia in Older People (EWGSOP), no intuito de promover melhor a identificação e o tratamento de sarcopenia, sugere, em consenso, que a mesma seja reconhecida como uma síndrome geriátrica. Dessa forma, recomenda o diagnóstico baseado na redução da massa muscular, obrigatoriamente associada à redução da força muscular e do desempenho físico. Entretanto, poucos são os estudos que estimaram a prevalência de sarcopenia em idosos usando o consenso do EWGSOP e nenhum realizou essa estimativa na América Latina. Além disso, esse conceito não foi analisado como fator de risco para incidência de incapacidade e, em populações com mais de 60 anos, como fator de risco para óbito. Contudo, dada as divergências conceituais entre sarcopenia e dinapenia, nenhum estudo comparou os resultados desses dois conceitos para os desfechos supracitados. Essa tese apresenta três artigos: O primeiro analisou a prevalência e os fatores associados à sarcopenia em idosos residentes no Município de São Paulo. A prevalência de sarcopenia encontrada foi de 15,4 por cento (16,1 por cento em mulheres e 14,4 por cento em homens). Idade avançada, prejuízo cognitivo, baixa renda, fumo, desnutrição e risco de desnutrição (p<0,05) foram fatores associados à sarcopenia. O segundo artigo comparou a associação da sarcopenia e da dinapenia com a incidência de incapacidade em mobilidade ou atividades instrumentais de vida diária e com incapacidade em atividades básicas e instrumentais de vida diária, organizadas num modelo conceitual hierárquico. A sarcopenia foi associada à incapacidade em mobilidade ou atividades instrumentais de vida diária (razão de risco relativo = 2,38, IC 95 por cento 1,10 5,17) enquanto a dinapenia não foi associada à incapacidade. O terceiro artigo comparou a associação da sarcopenia e da dinapenia com mortalidade. Tanto a sarcopenia (hazzard ratio = 1,52, IC 95 por cento 1,06 2,19) quanto a dinapenia (hazzard ratio = 2,04, IC 95 por cento 1,24 3,37) foram fatores de risco independentes para óbito. Contudo, a sarcopenia pode ser usada como instrumento de screening em Saúde Pública para identificar idosos sob-risco de desenvolver tipos prematuros de incapacidade e em condições clínicas que possam aumentar o risco de óbito / Originally, the sarcopenia term was defined as a decrease in muscle mass related to aging. Over the last decade, it became a broader term gathering reduced muscular strength (dynapenia) and reduced muscle mass. In 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) in order to improve the identification and treatment of sarcopenia suggests, in consensus, that it be recognized as a geriatric syndrome. This way, recommends the diagnosis based on low muscle mass, necessarily associated with low muscle strength and low physical performance. However, few studies have estimated the prevalence of sarcopenia in elderly using the EWGSOP definition and none made this estimation in Latin America. Furthermore, this concept was not analyzed as a risk factor for incidence of disability and, in people over 60 years, as a risk factor for death. However, given the conceptual divergences between sarcopenia and dynapenia, none study has compared the results of these two concepts to the outcomes above. This thesis presents three papers. The first one examined the prevalence and associated factors of sarcopenia among community dwelling elderly in São Paulo. The prevalence of sarcopenia was 15.4 per cent (16.1 per cent in women and 14.4 per cent in men). Advanced age, cognitive impairment, low income, smoking, undernutrition and risk for undernutrition (p<0.05) were factors associated with sarcopenia. The second paper compared the association of sarcopenia and dynapenia with the incidence of disability in mobility or instrumental activities of daily living and with disability in activities of daily living and instrumental activities of daily living, organized in a hierarchical conceptual model. Sarcopenia was associated with mobility or instrumental activities of daily living disability (relative risk ratio = 2.38, 95 per cent CI 1.10 5.17) while dynapenia was not associated with disability. The third paper compared the association of sarcopenia and dynapenia with mortality. Both sarcopenia (hazzard ratio = 1.52, 95 per cent CI 1.06 2.19) as dynapenia (hazzard ratio = 2.04, 95 per cent CI 1.24 3.37) were independent risk factors for death. Nevertheless, sarcopenia can be used as a screening in Public Health in order to identify elderly at risk of developing premature types of disability and with medical conditions that may increase the risk of death

Submitted by Alison Vanceto (alison-vanceto@hotmail.com) on 2017-08-24T12:16:41Z No. of bitstreams: 1 DissROM.pdf: 1802563 bytes, checksum: 8a20822e115118f79c74001c251e9156 (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-09-05T19:51:30Z (GMT) No. of bitstreams: 1 DissROM.pdf: 1802563 bytes, checksum: 8a20822e115118f79c74001c251e9156 (MD5) / Approved for entry into archive by Ronildo Prado (ronisp@ufscar.br) on 2017-09-05T19:51:38Z (GMT) No. of bitstreams: 1 DissROM.pdf: 1802563 bytes, checksum: 8a20822e115118f79c74001c251e9156 (MD5) / Made available in DSpace on 2017-09-05T19:57:23Z (GMT). No. of bitstreams: 1 DissROM.pdf: 1802563 bytes, checksum: 8a20822e115118f79c74001c251e9156 (MD5) Previous issue date: 2017-02-15 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Objective: The aim of the present study was to investigate associations between abdominal obesity/dynapenia/dynapenic abdominal obesity and a single fall/recurrent falls as well as determine the effect size of such associations using two cutoff points for dynapenia. Methods: A cross-sectional study was conducted with 1.063 older adults pertaining to the third wave of the Saúde, Bem Estar e Envelhecimento (SABE – Health, Wellbeing and Ageing) study. Abdominal obesity was defined as a waist circumference of >102 cm for men and > 88 cm for women. The following were the cutoff points for dynapenia: grip strength < 30 kg for men and < 20 kg for women or < 26 kg for men and < 16 kg for women. Dynapenic abdominal obesity was defined by the combination of abdominal obesity and dynapenia. Regarding the outcome, the individuals were classified as non-fallers, single fallers or recurrent fallers. Socioeconomic, neuropsychiatric and environmental factors as well as living habits, polypharmacy, health status and functionality were the control variables in the multinomial regression models. Results: Adopting a cutoff point of 30/20, only one association was found: dynapenic abdominal obesity and a single fall (RRR = 2.37; 95% CI: 1.48-3.80). However, adopting a cutoff point of 26/16, dynapenic abdominal obesity (RRR = 1.93; 95% CI: 1.09-3.44), abdominal obesity (RRR = 1.65; 95% CI: 1.08-2.52) and dynapenia (RRR = 1.77; 95% CI: 1.01-3.13) were associated with a single fall, with a larger effect size of the association with dynapenic abdominal obesity than the other two conditions. Moreover, dynapenia defined using the 26/16 cutoff point was associated with recurrent falls (RRR = 2.39; 95% CI: 1.19-4.82). Conclusions: The cutoff point used to define dynapenia affects associations between abdominal obesity/dynapenia/dynapenic abdominal obesity and a single fall/recurring falls. A cutoff point of 26/16 is better for identifying such associations. / Objetivo: Investigar a associação de obesidade abdominal (OA), dinapenia e obesidade abdominal dinapênica (OA/D) com queda única e quedas recorrentes, assim como o tamanho do efeito de tais associações, adotando duas notas de cortes para dinapenia. Método: Estudo transversal com 1.063 idosos provenientes da terceira onda do Estudo SABE. OA foi definida como circunferência de cintura > 102 cm para homens e > 88 cm para mulheres. As notas de corte para dinapenia foram: força de preensão manual < 30 kg para homens e < 20 kg para mulheres ou < 26 kg para homens e < 16 kg para mulheres. OA/D foi definida pela associação de OA e dinapenia. Quanto ao desfecho, os idosos foram classificados como não caidores, caidores únicos ou recorrentes. Fatores socioeconômicos, neuropsiquiátricos, ambientais, hábitos de vida, polifarmácia, estado de saúde e funcionalidade foram variáveis de controle nos modelos de regressão multinomial. Resultados: Adotando a nota de corte 30/20, encontramos somente a associação entre OA/D e queda única (RRR = 2,37 IC 95% 1,48–3,80). Em contrapartida, adotando a nota de corte 26/16 tanto a OA/D (RRR = 1,93 IC 95% 1,09–3,44), quanto a OA (RRR = 1,65 IC 95% 1,08–2,52) e a dinapenia (RRR = 1,77 IC 95% 1,01–3,13) associaram-se à queda única, sendo o tamanho do efeito da associação maior com OA/D do que com as duas condições isoladas. Além disso, a dinapenia definida com o corte 26/16 associou-se com quedas recorrentes (RRR = 2,39 IC 95% 1,19–4,82). Conclusões: A nota de corte adotada para definir dinapenia modifica as associações de OA, dinapenia, OA/D com queda única e recorrente, sendo o corte 26/16 melhor para identificá-las. / FAPESP: 2015/18291-7

Originalmente, o termo sarcopenia foi definido como a diminuição da massa muscular relacionada ao envelhecimento. Ao longo da última década, tornou-se um termo mais abrangente reunindo a redução da força muscular (dinapenia) à redução da massa muscular. Em 2010, o European Working Group on Sarcopenia in Older People (EWGSOP), no intuito de promover melhor a identificação e o tratamento de sarcopenia, sugere, em consenso, que a mesma seja reconhecida como uma síndrome geriátrica. Dessa forma, recomenda o diagnóstico baseado na redução da massa muscular, obrigatoriamente associada à redução da força muscular e do desempenho físico. Entretanto, poucos são os estudos que estimaram a prevalência de sarcopenia em idosos usando o consenso do EWGSOP e nenhum realizou essa estimativa na América Latina. Além disso, esse conceito não foi analisado como fator de risco para incidência de incapacidade e, em populações com mais de 60 anos, como fator de risco para óbito. Contudo, dada as divergências conceituais entre sarcopenia e dinapenia, nenhum estudo comparou os resultados desses dois conceitos para os desfechos supracitados. Essa tese apresenta três artigos: O primeiro analisou a prevalência e os fatores associados à sarcopenia em idosos residentes no Município de São Paulo. A prevalência de sarcopenia encontrada foi de 15,4 por cento (16,1 por cento em mulheres e 14,4 por cento em homens). Idade avançada, prejuízo cognitivo, baixa renda, fumo, desnutrição e risco de desnutrição (p<0,05) foram fatores associados à sarcopenia. O segundo artigo comparou a associação da sarcopenia e da dinapenia com a incidência de incapacidade em mobilidade ou atividades instrumentais de vida diária e com incapacidade em atividades básicas e instrumentais de vida diária, organizadas num modelo conceitual hierárquico. A sarcopenia foi associada à incapacidade em mobilidade ou atividades instrumentais de vida diária (razão de risco relativo = 2,38, IC 95 por cento 1,10 5,17) enquanto a dinapenia não foi associada à incapacidade. O terceiro artigo comparou a associação da sarcopenia e da dinapenia com mortalidade. Tanto a sarcopenia (hazzard ratio = 1,52, IC 95 por cento 1,06 2,19) quanto a dinapenia (hazzard ratio = 2,04, IC 95 por cento 1,24 3,37) foram fatores de risco independentes para óbito. Contudo, a sarcopenia pode ser usada como instrumento de screening em Saúde Pública para identificar idosos sob-risco de desenvolver tipos prematuros de incapacidade e em condições clínicas que possam aumentar o risco de óbito / Originally, the sarcopenia term was defined as a decrease in muscle mass related to aging. Over the last decade, it became a broader term gathering reduced muscular strength (dynapenia) and reduced muscle mass. In 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) in order to improve the identification and treatment of sarcopenia suggests, in consensus, that it be recognized as a geriatric syndrome. This way, recommends the diagnosis based on low muscle mass, necessarily associated with low muscle strength and low physical performance. However, few studies have estimated the prevalence of sarcopenia in elderly using the EWGSOP definition and none made this estimation in Latin America. Furthermore, this concept was not analyzed as a risk factor for incidence of disability and, in people over 60 years, as a risk factor for death. However, given the conceptual divergences between sarcopenia and dynapenia, none study has compared the results of these two concepts to the outcomes above. This thesis presents three papers. The first one examined the prevalence and associated factors of sarcopenia among community dwelling elderly in São Paulo. The prevalence of sarcopenia was 15.4 per cent (16.1 per cent in women and 14.4 per cent in men). Advanced age, cognitive impairment, low income, smoking, undernutrition and risk for undernutrition (p<0.05) were factors associated with sarcopenia. The second paper compared the association of sarcopenia and dynapenia with the incidence of disability in mobility or instrumental activities of daily living and with disability in activities of daily living and instrumental activities of daily living, organized in a hierarchical conceptual model. Sarcopenia was associated with mobility or instrumental activities of daily living disability (relative risk ratio = 2.38, 95 per cent CI 1.10 5.17) while dynapenia was not associated with disability. The third paper compared the association of sarcopenia and dynapenia with mortality. Both sarcopenia (hazzard ratio = 1.52, 95 per cent CI 1.06 2.19) as dynapenia (hazzard ratio = 2.04, 95 per cent CI 1.24 3.37) were independent risk factors for death. Nevertheless, sarcopenia can be used as a screening in Public Health in order to identify elderly at risk of developing premature types of disability and with medical conditions that may increase the risk of death