Abstract
OBJECTIVES:
The ability of the Timed Up and Go test to predict sarcopenia has not been evaluated previously. The objective of this study was to evaluate the accuracy of the Timed Up and Go test for predicting sarcopenia in elderly hospitalized patients.
METHODS:
This cross-sectional study analyzed 68 elderly patients (≥60 years of age) in a private hospital in the city of Salvador-BA, Brazil, between the 1st and 5th day of hospitalization. The predictive variable was the Timed Up and Go test score, and the outcome of interest was the presence of sarcopenia (reduced muscle mass associated with a reduction in handgrip strength and/or weak physical performance in a 6-m gait-speed test). After the descriptive data analyses, the sensitivity, specificity and accuracy of a test using the predictive variable to predict the presence of sarcopenia were calculated.
RESULTS:
In total, 68 elderly individuals, with a mean age 70.4±7.7 years, were evaluated. The subjects had a Charlson Comorbidity Index score of 5.35±1.97. Most (64.7%) of the subjects had a clinical admission profile; the main reasons for hospitalization were cardiovascular disorders (22.1%), pneumonia (19.1%) and abdominal disorders (10.2%). The frequency of sarcopenia in the sample was 22.1%, and the mean length of time spent performing the Timed Up and Go test was 10.02±5.38 s. A time longer than or equal to a cutoff of 10.85 s on the Timed Up and Go test predicted sarcopenia with a sensitivity of 67% and a specificity of 88.7%. The accuracy of this cutoff for the Timed Up and Go test was good (0.80; IC=0.66-0.94; p=0.002).
CONCLUSION:
The Timed Up and Go test was shown to be a predictor of sarcopenia in elderly hospitalized patients.
Limitation of mobility; sarcopenia; elderly; hospital
INTRODUCTION
The performance of daily living activities, as evaluated with specific physical
tests, is associated with clinically relevant outcomes, such as mortality and
quality of life 11. Fritz S, Lusardi M. White paper: “walking speed: the sixth
vital sign”. J Geriatr Phys Ther. 2009;32(2):46-9,
http://dx.doi.org/10.1519/00139143-200932020-00002.
http://dx.doi.org/10.1519/00139143-20093...
. It might be
important for elderly hospitalized patients to undergo physical tests to evaluate
skeletal muscle function, which could be severely compromised by aging and
comorbidities 11. Fritz S, Lusardi M. White paper: “walking speed: the sixth
vital sign”. J Geriatr Phys Ther. 2009;32(2):46-9,
http://dx.doi.org/10.1519/00139143-200932020-00002.
http://dx.doi.org/10.1519/00139143-20093...
.
Aging is responsible for changes in peripheral muscle mass and strength, particularly
after 50 years of age, when muscle mass declines by 1 to 2% per year, and muscle
strength declines by 1.5 to 5% per year 22. Hughes VA, Frontera WR, Roubenoff R, Evans WJ, Singh MA.
Longitudinal changes in body composition in older men and women: role of body
weight change and physical activity. Am J Clin Nutr.
2002;76(2):473-81.. Longitudinal studies have demonstrated that reductions in muscle
strength predict mortality over a period of years to a greater extent than do
changes in skeletal muscle mass 3. Gale CR, Martyn CN, Cooper C, Sayer AA. Grip strength, body
composition, and mortality. Int J Epidemiol. 2007;36(1):228-35,
http://dx.doi.org/10.1093/ije/dyl224.
http://dx.doi.org/10.1093/ije/dyl224...
3,44. Newman AB, Kupelian V, Visser M, Simonsick EM, Goodpaster BH,
Kritchevsky SB, et al. Strength, but not muscle mass, is associated with
mortality in the health, aging and body composition study cohort. J Gerontol A
Biol Sci Med Sci. 2006;61(1):72-7,
http://dx.doi.org/10.1093/gerona/61.1.72.
http://dx.doi.org/10.1093/gerona/61.1.72...
. Additionally, studies have
noted that physical tests might be useful for evaluating reductions in mobility in
elderly individuals; these reductions might be related to decreased muscle mass and
strength, which is known as sarcopenia 55. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T,
Landi F, et al. Sarcopenia: European consensus on definition and diagnosis:
Report of the European Working Group on Sarcopenia in Older People. Age Ageing.
2010;39(4):412-23, http://dx.doi.org/10.1093/ageing/afq034.
http://dx.doi.org/10.1093/ageing/afq034...
. In addition to muscle-mass and muscle-strength parameters, gait speed
has been evaluated to assess physical performance; in particular, the Timed Up and
Go (TUG) is a simple test that could be used even in a limited-resource environment
to assess physical performance 55. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T,
Landi F, et al. Sarcopenia: European consensus on definition and diagnosis:
Report of the European Working Group on Sarcopenia in Older People. Age Ageing.
2010;39(4):412-23, http://dx.doi.org/10.1093/ageing/afq034.
http://dx.doi.org/10.1093/ageing/afq034...
.
Additionally, elderly patients readily perform the TUG test, and TUG-test scores are
well correlated with the risk of falling in this patient group 6. Mathias S, Nayak US, Isaacs B. Balance in elderly patients: the
“Get-up and go” test. Arch phys Med Rehabil.
1986;67(6):387-9.6,77. Beauchet O, Fantino B, Allali G, Muir SW, Montero-Odasso M,
Annweiler C. Timed Up and Go test and risk of falls in older adults: a
systematic review. Nutr Health Aging. 2011;15(10):933-8,
http://dx.doi.org/10.1007/s12603-011-0062-0.
http://dx.doi.org/10.1007/s12603-011-006...
. In
a recent study that evaluated elderly patients in a primary care setting, the cutoff
TUG-test score for predicting falls was a value greater than 12.47 s 88. Alexandre TS, Meira DM, Rico NC, Mizuta SK. Accuracy of Timed Up
and Go Test for screening risk of falls among community-dwelling elderly. Rev
Bras Fisioter. 2012;16(5):381-8,
http://dx.doi.org/10.1590/S1413-35552012005000041.
http://dx.doi.org/10.1590/S1413-35552012...
. To our knowledge, the ability of
the TUG test to predict sarcopenia has not been evaluated.
The goal of this study was to evaluate the accuracy of the TUG test in predicting sarcopenia in a sample of elderly inpatients.
METHODS
This work was a cross-sectional study conducted from August 2013 to January 2014 in a hospital that assists patients from public and private healthcare systems in Brazil. The inclusion criteria for this study were age ≥60 years, body mass index (BMI) <30 kg/m2, enrollment between the 1st and 5th day of hospitalization, self-report of walking independently and without external help prior to hospitalization, a physician’s permission to walk without assistance after hospitalization, and no use of vasoactive and/or inotropic drugs. The exclusion criteria were peripheral oxygen saturation (SpO2) lower than 90% during an evaluation, an increase in heart rate (HR) of more than 30% of the baseline value (before the test began) and dyspnea or discomfort during the performance of the tests. This project was approved by the ethics committee of the Bahia School of Medicine and Public Health (protocol number 336.469), and all of the study participants signed informed consent forms and were provided information regarding participation in the study.
Measurements
First, anthropometric measurements were taken, and handgrip strength and physical performance were measured using the gait-speed and TUG tests. Additionally, we assessed self-reports of falls during the previous year and of cognitive function. The data were obtained from the patient records including the diagnoses at medical admission, the admission profile (surgical or clinical), the Charlson Comorbidity Index score and the length of stay at the time of the data collection.
The diagnostic criteria for sarcopenia were a reduction in skeletal muscle mass
(SMM), with reduced handgrip strength and/or poor physical performance in a 6-m
gait-speed test. The SMM was obtained using the Lee anthropometric equation,
which yields results that are highly correlated with the SMM calculated with
magnetic resonance data 99. Lee RC, Wang Z, Heo M, Ross R, Janssen I, Heymsfield SB.
Total-body skeletal muscle mass: development and cross-validation of
anthropometric prediction models. Am J Clin Nutr.
2000;72(3):796-803. and
dual-energy X-ray absorptiometry (DXA, previously DEXA) data 10. Rech CR, Dellagrana RA, Marucci MFN, Petroski EL. Validade de
equações antropométricas para estimar a massa muscular em idosos.
Rev Bras de Cineantropom e Desempenho Hum. 2012;14(1):23-31.10,1111. Newman AB, Kupelian V, Visser M, Simonsick E, Goodpaster B,
Nevitt M. Sarcopenia: Alternative definitions and associations with lower
extremity function. J Am Geriatr Soc. 2003;51(11):1602-09,
http://dx.doi.org/10.1046/j.1532-5415.2003.51534.x.
http://dx.doi.org/10.1046/j.1532-5415.20...
. SMM was calculated as a function of
weight and height as follows: (height [m] × 0.244 × body
mass) + (7.8 × height) + (6.6 × sex) - (0.098 × age)
+ (ethnicity - 3.3). The SMM index was then calculated by dividing an
individual’s SMM (kg) by his or her height squared (m2). The
criteria used to identify a reduction in SMM were values ≤6.37
kg/m2 for women and ≤8.90 kg/m2 for men, which
are equivalent to 20% of lowest percentile distribution reported by Alexandre et
al. 1212. Alexandre TS, Duarte YAO, Santos JLF, Wong R, Lebrão ML
Prevalence and associated factors of sarcopenia among elderly in Brazil:
Findings from the study SABE. J Nutr Health Aging.
2014;18(3):284-90..
To evaluate handgrip strength, each subject was seated in a chair, with the
elbows at 90°, and was asked to exert maximum force on a Saehan dynamometer
(SAEHAN CORPORATION, Yangdeok-Dong, Masan, South Korea) 1313. Reis MM, Arantes PMM. Medida da força de preensão
manual - validade e confiabilidade do dinamômetro Saehan. Fisioterapia e
Pesquisa. 2011;18(2):176-81,
http://dx.doi.org/10.1590/S1809-29502011000200013.
http://dx.doi.org/10.1590/S1809-29502011...
. This measurement was performed three times
with a rest interval of one minute between measurements; the greatest
measurement was reported. The criteria for muscle weakness indicative of
sarcopenia were values lower than 20 kg in women and lower than 30 kg in men
1414. Lauretani F, Russo CR, Bandinelli S, Bartali B, Cavazzini C, Di
lorio A, et al. Age-associated changes in skeletal muscles and their effect on
mobility: an operational diagnosis of sarcopenia. J Appl Phys.
2003;95(5):1851-60..
The 6-m walking test was conducted to assess an individual’s physical
performance. To perform this test, each subject was asked to walk 10 m on a
flat, straight course at the fastest possible speed, and the time required to
walk the central 6 m was measured. The highest speed among three measurements
was used in the analyses, with values lower than or equal to 0.8 m/s being
considered weak physical performance indicative of sarcopenia 1515. Abellan van KG, Rolland Y, Andrieu S, Bauer J, Beauchet O,
Bonnefoy M, et al. Gait speed as a marker of adverse outcomes in
community-dwelling older people an International Academy on Nutrition and Aging
(IANA) Task Force. J Nutr Health Aging. 2009;13(10):881-9,
http://dx.doi.org/10.1007/s12603-009-0246-z.
http://dx.doi.org/10.1007/s12603-009-024...
. To measure physical
performance using the TUG test, each individual was asked to stand up from a
seated position, walk 3 m and then return to a seated position on the same
chair, while a previously trained physical therapist measured the time (s)
required to perform this task 1616. Rose DJ, Jones CJ, Lucchese N. Predicting the probability of
falls in community-residing older adults using the 8-Foot Up and Go: a new
measure of functional mobility. J Aging Phys Act.
2002;10(4):466-75..
The body mass index (BMI) of each subject was obtained by dividing his or her
body weight (kg) by his or her squared height (m2). The World Health
Organization criteria were used to classify the subjects as low-weight
(BMI<18.5), eutrophic (18.5<BMI≤24.99), overweight
(25≤BMI≤29.99) or obese (BMI≥30.00) 1717. Diet, nutrition and the prevention of chronic diseases. World
Health Organ. Tech Rep Ser. 2003; 916: 1-149.. Cognitive function was evaluated using the
mini-mental state examination (MMSE) 1818. Lourenço RA, Veras RP. Mini-Exame do Estado Mental:
características psicométricas em idosos ambulatoriais. Rev Saúde
Pública. 2006;40(4):712-9., which quantifies various cognitive abilities, such as
orientation, attention, calculation, visuo-constructive ability, language and
evocation, with a score that ranges from 0 to 30 points. The Charlson
Comorbidity Index was used to evaluate the presence of comorbidities, and the
data were collected within the first 24 hours 1919. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of
classifying prognostic comorbidity in longitudinal studies: development and
validation. J Chronic Dis 1987;40(5):373-83,
http://dx.doi.org/10.1016/0021-9681(87)90171-8.
http://dx.doi.org/10.1016/0021-9681(87)9...
.
Statistical analysis
The numerical data were described by the means and standard deviations, and the categorical data were described by the proportions and confidence intervals. The accuracy was evaluated using receiver operating characteristic (ROC) curves obtained from the sensitivity and specificity analyses; the TUG test measured the physical performance as the predictive variable and the presence of sarcopenia as the outcome variable. Student’s t-test was used for the intergroup comparisons of the numerical variables (the age, muscle mass index, mental function, length of hospital stay at the time of the data collection, Charlson Comorbidity Index score and physical performance) using a cut-off of ≥10.85 s on the TUG test for the prediction of sarcopenia. These analyses were performed using the SPSS statistical software, version 14.0.
RESULTS
In total, 68 elderly hospitalized individuals (58.8% males) were evaluated, and 22.1% of these patients had sarcopenia. The mean age of the study subjects was 70.4±7.7 years, and the mean BMI was 25.7±3.3 kg/m2. Most (64.7%) of the study subjects had a clinical admission profile. The major reasons for hospitalization were cardiovascular disorders (22.1%), pneumonia (19.1%), abdominal surgery (19.1%) and abdominal disorders (10.2%). The mean duration of hospitalization at the time of the data collection was 2.76±1.71 days, and the subjects’ mean Charlson Comorbidity Index score was 5.35±1.97. Regarding the self-reports of falls in the previous year, 30.9% of the subjects reported having had at least one fall in the previous year (Table 1). The accuracy of TUG was considered moderate (0.80; IC = 0.66-0.94; p-value = 0.001) for predicting sarcopenia in the sample studied. After the analysis of the ROC curve, we observed that TUG presented a sensitivity of 66.7% and specificity of 88.7% for the prediction of sarcopenia (Table 2). The sarcopenia predictor cut-off point was a TUG≥10.85 seconds, found in the point of greatest accuracy in the ROC curve (Figure 1). In the intergroup comparison, the elderly with a physical performance predictive of sarcopenia (TUG≥10.85 seconds)had worse cognitive function, were older and presented higher scores of the Charlson comorbidity index and a lower quantity of skeletal muscle mass. There were no significant differences in the comparison between the mean duration of hospitalization (Table 3).
Accuracy of the test Time Up and Go to predict sarcopenia in the sample of 68 elderly hospitalized patients.
Diagnostic performance of the Timed Up and Go test for predicting sarcopenia in the sample of 68 elderly hospitalized patients.
DISCUSSION
This study found that the TUG test predicted sarcopenia in elderly hospitalized patients with good accuracy. This finding suggests that this test might be a useful in the evaluation of at risk-patients with similar profiles in the hospital environment. This study evaluated, for the first time, the ability of the TUG test of physical performance to predict the presence of sarcopenia.
The cut-off point that predicted sarcopenia in this study was a time longer than or
equal to 10.85 s in the performance of the TUG test. This time was lower than the
time that is predictive of falls in elderly Brazilians (≥12.47 s) 88. Alexandre TS, Meira DM, Rico NC, Mizuta SK. Accuracy of Timed Up
and Go Test for screening risk of falls among community-dwelling elderly. Rev
Bras Fisioter. 2012;16(5):381-8,
http://dx.doi.org/10.1590/S1413-35552012005000041.
http://dx.doi.org/10.1590/S1413-35552012...
. No reference values for the TUG
test exist for the prediction of sarcopenia, according to the definitions of the
consensus of The European Working Group on Sarcopenia in Older People 55. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T,
Landi F, et al. Sarcopenia: European consensus on definition and diagnosis:
Report of the European Working Group on Sarcopenia in Older People. Age Ageing.
2010;39(4):412-23, http://dx.doi.org/10.1093/ageing/afq034.
http://dx.doi.org/10.1093/ageing/afq034...
, which limits comparisons with
reference values. One of the reasons that the TUG test predicts sarcopenia with good
accuracy might be the significant muscular participation that is required for
transferring rapidly from a sitting position to a standing position, which is one of
the test activities.
Falsarella et al. 2020. Falsarella GR, Coimbra IB, Barcelos CC, Lartelli I, Montedori
KT, Santos MNJ, et al. Influence of muscle mass and bone mass on the mobility of
elderly womem: an observational study. BMC Geriatrics. 2014;14(13):1-7,
http://dx.doi.org/10.1186/1471-2318-14-13.
http://dx.doi.org/10.1186/1471-2318-14-1...
evaluated the
influence of muscle and bone mass on the functionality of 99 elderly women and
observed that reduced muscle mass was associated with poor physical performance in
the gait-speed and TUG tests. In this study, reduced muscle mass
(p<0.01) was observed in elderly patients with a poor physical
performance (time ≥10.85 s on the TUG test) in an intergroup comparison; this
finding suggests that the skeletal muscle mass variable might be associated with
performance on the TUG test. One reason for this association might be the changes in
muscle composition during aging; these alterations might occur in parallel with
reduction in muscle strength and thereby affect physical performance in this
population.
The individuals with the worst physical performance exhibited worse cognitive
function. This finding suggests that a relationship might exist between these
variables. This study had a cross-sectional design, and whether a causal
relationship exists between these variables could not be determined; however, a
recent study did not find an association between sarcopenia and cognitive
dysfunction after adjusting for the confounding variables 2121. Kan GA, Cesari M, Gillette-Guyonnet S, Dupuy C, Nourhashémi
F, Schott A, et al. Sarcopenia and cognitive impairment in elderly women:
results from the EPIDOS cohort. Age and Ageing 2013;42(2):196-202,
http://dx.doi.org/10.1093/ageing/afs173.
http://dx.doi.org/10.1093/ageing/afs173...
. Additionally, high Charlson Comorbidity Index
scores in elderly subjects with poor physical performance suggest that a greater
presence of comorbidities might be associated with changes in performance; changes
in performance might result from sarcopenia secondary to one or more comorbidities,
in addition to primary sarcopenia, which occurs with aging 55. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T,
Landi F, et al. Sarcopenia: European consensus on definition and diagnosis:
Report of the European Working Group on Sarcopenia in Older People. Age Ageing.
2010;39(4):412-23, http://dx.doi.org/10.1093/ageing/afq034.
http://dx.doi.org/10.1093/ageing/afq034...
.
Using sensitive tests to identify risk factors for patients is crucial because such tests facilitate the identification of patients who would benefit from physical therapy and specific clinical interventions. This study demonstrated that the TUG test might be capable of identifying patients with and without sarcopenia because it had a sensitivity of 67% and a specificity of 88.7%. The diagnosis of sarcopenia was based in part on the estimated skeletal muscle mass, which was computed using an anthropometric equation that exhibited high sensitivity and specificity with the gold-standard measurement techniques used in previous studies, including a recent study in a Brazilian population 9. Lee RC, Wang Z, Heo M, Ross R, Janssen I, Heymsfield SB. Total-body skeletal muscle mass: development and cross-validation of anthropometric prediction models. Am J Clin Nutr. 2000;72(3):796-803.9,1010. Rech CR, Dellagrana RA, Marucci MFN, Petroski EL. Validade de equações antropométricas para estimar a massa muscular em idosos. Rev Bras de Cineantropom e Desempenho Hum. 2012;14(1):23-31..
In spite of this high correlation, anthropometry is considered to result in
measurements that are less accurate than those obtained using gold-standard
measurement methods (magnetic resonance imaging, computed tomography and dual energy
X-ray absorptiometry) 2222. Thomas DR. Sarcopenia. Clin Geriatr Med. 2010;26(2):331-46,
http://dx.doi.org/10.1016/j.cger.2010.02.012.
http://dx.doi.org/10.1016/j.cger.2010.02...
. The
feasibility of using these more accurate instruments is restricted by operational
and financial aspects of daily clinical practice. Another consideration is that the
use of the SMM obtained with the anthropometric equation, as with the use of the
BMI, is limited in that it does not distinguish among the different components of
body mass, such as muscle, bone and fat. This limitation suggests that this
instrument should not be used to measure the responses to interventions over time.
Although the physical tests did not exhibit the level of accuracy of the
gold-standard methods, using these tests is more feasible in daily practice, and
their use might facilitate identification of patients with sarcopenia among elderly
hospitalized patients. This factor is of extreme importance because the elderly
population is more vulnerable to complications 23. Cawthon PM, Maeshall LM, Michael Y, Dam T, Ensrud KE,
Barret-Connor E, et al. Frailty in older men: prevalence, progression, and
relationship with mortality. J Am Soc Geriatr. 2007;55(8):1216-23,
http://dx.doi.org/10.1111/(ISSN)1532-5415.
http://dx.doi.org/10.1111/(ISSN)1532-541...
23,2424. Di Monaco M, Vallero F, Di Monaco R, Tappero R. Prevalence of
sarcopenia and its association with osteoporosis in 313 older womem following a
hip fracture. Arch Gerontol Geriatr. 2011;52(1):71-4,
http://dx.doi.org/10.1016/j.archger.2010.02.002.
http://dx.doi.org/10.1016/j.archger.2010...
,
particularly in the musculoskeletal system, and the consequences, including falls or
death, might be severe.
Another limitation is that the studied population included only elderly patients who were able to walk without any assistance; this limitation prevents use of the TUG test to predict sarcopenia in elderly individuals who need assistive devices.
The Timed Up and Go test was shown to be a good predictor of sarcopenia in elderly hospitalized patients. Evaluating physical performance with this test might provide another method for identifying elderly patients with sarcopenia in cases in which a patient’s TUG test time is over 10.85 s. In this study, the patients with the worst physical performance were older and had worse cognitive function and less SMM.
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-
1Fritz S, Lusardi M. White paper: “walking speed: the sixth vital sign”. J Geriatr Phys Ther. 2009;32(2):46-9, http://dx.doi.org/10.1519/00139143-200932020-00002.
» http://dx.doi.org/10.1519/00139143-200932020-00002 -
2Hughes VA, Frontera WR, Roubenoff R, Evans WJ, Singh MA. Longitudinal changes in body composition in older men and women: role of body weight change and physical activity. Am J Clin Nutr. 2002;76(2):473-81.
-
3Gale CR, Martyn CN, Cooper C, Sayer AA. Grip strength, body composition, and mortality. Int J Epidemiol. 2007;36(1):228-35, http://dx.doi.org/10.1093/ije/dyl224.
» http://dx.doi.org/10.1093/ije/dyl224 -
4Newman AB, Kupelian V, Visser M, Simonsick EM, Goodpaster BH, Kritchevsky SB, et al. Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort. J Gerontol A Biol Sci Med Sci. 2006;61(1):72-7, http://dx.doi.org/10.1093/gerona/61.1.72.
» http://dx.doi.org/10.1093/gerona/61.1.72 -
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» http://dx.doi.org/10.1093/ageing/afq034 -
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7Beauchet O, Fantino B, Allali G, Muir SW, Montero-Odasso M, Annweiler C. Timed Up and Go test and risk of falls in older adults: a systematic review. Nutr Health Aging. 2011;15(10):933-8, http://dx.doi.org/10.1007/s12603-011-0062-0.
» http://dx.doi.org/10.1007/s12603-011-0062-0 -
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» http://dx.doi.org/10.1590/S1413-35552012005000041 -
9Lee RC, Wang Z, Heo M, Ross R, Janssen I, Heymsfield SB. Total-body skeletal muscle mass: development and cross-validation of anthropometric prediction models. Am J Clin Nutr. 2000;72(3):796-803.
-
10Rech CR, Dellagrana RA, Marucci MFN, Petroski EL. Validade de equações antropométricas para estimar a massa muscular em idosos. Rev Bras de Cineantropom e Desempenho Hum. 2012;14(1):23-31.
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11Newman AB, Kupelian V, Visser M, Simonsick E, Goodpaster B, Nevitt M. Sarcopenia: Alternative definitions and associations with lower extremity function. J Am Geriatr Soc. 2003;51(11):1602-09, http://dx.doi.org/10.1046/j.1532-5415.2003.51534.x.
» http://dx.doi.org/10.1046/j.1532-5415.2003.51534.x -
12Alexandre TS, Duarte YAO, Santos JLF, Wong R, Lebrão ML Prevalence and associated factors of sarcopenia among elderly in Brazil: Findings from the study SABE. J Nutr Health Aging. 2014;18(3):284-90.
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13Reis MM, Arantes PMM. Medida da força de preensão manual - validade e confiabilidade do dinamômetro Saehan. Fisioterapia e Pesquisa. 2011;18(2):176-81, http://dx.doi.org/10.1590/S1809-29502011000200013.
» http://dx.doi.org/10.1590/S1809-29502011000200013 -
14Lauretani F, Russo CR, Bandinelli S, Bartali B, Cavazzini C, Di lorio A, et al. Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia. J Appl Phys. 2003;95(5):1851-60.
-
15Abellan van KG, Rolland Y, Andrieu S, Bauer J, Beauchet O, Bonnefoy M, et al. Gait speed as a marker of adverse outcomes in community-dwelling older people an International Academy on Nutrition and Aging (IANA) Task Force. J Nutr Health Aging. 2009;13(10):881-9, http://dx.doi.org/10.1007/s12603-009-0246-z.
» http://dx.doi.org/10.1007/s12603-009-0246-z -
16Rose DJ, Jones CJ, Lucchese N. Predicting the probability of falls in community-residing older adults using the 8-Foot Up and Go: a new measure of functional mobility. J Aging Phys Act. 2002;10(4):466-75.
-
17Diet, nutrition and the prevention of chronic diseases. World Health Organ. Tech Rep Ser. 2003; 916: 1-149.
-
18Lourenço RA, Veras RP. Mini-Exame do Estado Mental: características psicométricas em idosos ambulatoriais. Rev Saúde Pública. 2006;40(4):712-9.
-
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» http://dx.doi.org/10.1016/0021-9681(87)90171-8 -
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Publication Dates
-
Publication in this collection
May 2015
History
-
Received
14 Nov 2014 -
Reviewed
15 Dec 2014 -
Accepted
20 Feb 2015