Acknowledgments - Monash University
Victoria UniversityThe Western Centre for Health Research and EducationThe Relationship between Sarcopenia, Obesity & Bone HealthLachlan McMillan; BBioMedScThesis submitted to Victoria University for the degree of Bsc- BioMedSc with HonoursStudent ID: 4526232Supervisor: Associate Professor Alan HayesCo-supervisor: Dr Craig Goodman Dr David ScottSubmission Date:30/10/2015Western Centre for Research Health and EducationDeclarationDeclaration by Scholar: I, ...................................................................... (student’s name) certify that ? The thesis comprises only my original work, except where indicated in the accompanying Acknowledgement statement * ? The thesis conforms to the specifications outlined in the Honours Handbook. Signature:_________________________ Date:_____________________________ Declaration by Supervisor: I confirm that the declaration above of.................................................(student’s name) thesis is a true and fair representation of the student’s work. Supervisor: Assoc Prof Alan HayesSignature:_________________ Date:_____________________AcknowledgmentsTo begin, I must thank my primary supervisor Alan Hayes. You have provided me with an exceptional basis for future studies and your support throughout the year in a range of endeavours is enormously appreciated. Thank you for always being there for assistance when I needed it, and for providing the critical hand in developing my clinical, real-world research experience.To David Scott; your help throughout the year has been invaluable, and I cannot thank you enough for your guidance upon the project. Your professionalism and desire to help has given me an excellent grounding and understanding of the requirements of research, and it has been an experience I will always remember and understand the importance of.To Dr Craig Goodman; your assistance with the project has been vital, and much of what I have produced to date would not have been possible without your guidance.To our research assistant and colleague Catherine Shore-Lorenti, your professionalism and dedication to the project and us as students was unwavering and you set the example on a weekly basis; a lesson which I will take forward into my own career.To my fellow honours students Jake and Menas - congratulations on making it to the end of the year. The early starts and late nights we shared recruiting patients, giving presentations and analysing data will not easily be forgotten and I wish you both the best of the luck in the future with your studies.To all other members of the WCHRE who I have dealt with and no doubt annoyed with boundless questions I thank you for your patience and understanding, particularly to Eva, Elif, Brittany, James, Cara and Troy.Contents TOC \o "1-3" \h \z \u Declaration PAGEREF _Toc433969792 \h iiAcknowledgments PAGEREF _Toc433969793 \h iiiAbstract PAGEREF _Toc433969794 \h viBackground PAGEREF _Toc433969795 \h viMethods PAGEREF _Toc433969796 \h viResults PAGEREF _Toc433969797 \h viConclusion PAGEREF _Toc433969798 \h viiAbbreviations PAGEREF _Toc433969799 \h viiiList of Figures PAGEREF _Toc433969800 \h viiiList of Tables PAGEREF _Toc433969801 \h ixAppendices PAGEREF _Toc433969802 \h ix1.Introduction PAGEREF _Toc433969803 \h 11.1 Skeletal Muscle Structure & Function PAGEREF _Toc433969804 \h 11.2 Muscle Strength and Mass PAGEREF _Toc433969805 \h 31.3 Sarcopenia, Dynapenia and Aging PAGEREF _Toc433969806 \h 41.4 Mechanisms of Sarcopenia PAGEREF _Toc433969807 \h 61.5 Sarcopenia and Obesity Synergism PAGEREF _Toc433969808 \h 61.6 Sarcopenia and Adipose Interactions with Osseous Tissue PAGEREF _Toc433969809 \h 71.7 Rationale PAGEREF _Toc433969810 \h 102.Aim and Hypotheses PAGEREF _Toc433969811 \h 112.1 Aims PAGEREF _Toc433969812 \h 112.2 Hypotheses PAGEREF _Toc433969813 \h 113. Methods PAGEREF _Toc433969814 \h 113.1 Participant Recruitment and Eligibility PAGEREF _Toc433969815 \h 11Inclusion Criteria: PAGEREF _Toc433969816 \h 12Exclusion Criteria: PAGEREF _Toc433969817 \h 123.2 Clinical Testing PAGEREF _Toc433969818 \h 13Blood Sampling: PAGEREF _Toc433969819 \h 13Anthropometry: PAGEREF _Toc433969820 \h 14Self-Administered Questionnaire: PAGEREF _Toc433969821 \h 15Compositional Analysis: PAGEREF _Toc433969822 \h 15Strength Assessment and Short Physical Performance Battery PAGEREF _Toc433969823 \h 18Balance Assessment: PAGEREF _Toc433969824 \h 203.3 Sarcopenia and Obesity Definitions PAGEREF _Toc433969825 \h 20Contribution to the study PAGEREF _Toc433969826 \h 244.Participant Grouping PAGEREF _Toc433969827 \h 245.Statistical Analysis PAGEREF _Toc433969828 \h 266.Results PAGEREF _Toc433969829 \h 266.1 Comparison between 2013/14 and 2015 cohorts PAGEREF _Toc433969830 \h 266.2 Appendicular Lean Mass and Obesity PAGEREF _Toc433969831 \h 286.3 Gait Speed PAGEREF _Toc433969832 \h 306.4 Hand Grip Strength PAGEREF _Toc433969833 \h 316.5 Leg Extension Strength PAGEREF _Toc433969834 \h 346.6 Whole-Body Bone Density and Adiposity PAGEREF _Toc433969835 \h 357.Discussion PAGEREF _Toc433969836 \h 388.Limitations PAGEREF _Toc433969837 \h 439.Future Directions PAGEREF _Toc433969838 \h 4410.Conclusion PAGEREF _Toc433969839 \h 4511.References PAGEREF _Toc433969840 \h 4512.Appendices PAGEREF _Toc433969841 \h 65Table 4 PAGEREF _Toc433969842 \h 65Table 5 PAGEREF _Toc433969843 \h 67Table 6 PAGEREF _Toc433969844 \h 69Table 7 PAGEREF _Toc433969845 \h 72Table 8 PAGEREF _Toc433969846 \h 74Table 9 PAGEREF _Toc433969847 \h 78Table 10. PAGEREF _Toc433969848 \h 82Table 11. PAGEREF _Toc433969849 \h 85Participant Information and Consent Form PAGEREF _Toc433969850 \h 88DATA COLLECTION BOOKLET PAGEREF _Toc433969851 \h 94Questionnaire Document PAGEREF _Toc433969852 \h 102General Questionnaire PAGEREF _Toc433969853 \h 103EQ-5D PAGEREF _Toc433969854 \h 110AQoL-6D PAGEREF _Toc433969855 \h 111The Modified Falls Efficacy Scale PAGEREF _Toc433969856 \h 117AbstractBackgroundMuscle mass and strength are important factors to maintain healthy aging, yet have not been adequately investigated in older populations suffering from obesity. Concomitant obesity with lowered muscle mass and strength may place older adults at a higher risk of poor physical function and increased morbidity and mortality. The combined impact these conditions have upon bone mineral density (BMD) and inherent bone strength are unclear.MethodsSixty-five (34.3% male) community dwelling adults (age 62.8 ± 8.0 mean ± SD) completed physical strength assessments, and muscle and bone composition by dual-energy x-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT). Individuals were classed as obese using total body fat percentage cut offs (≥30% Men ≥40% Women) or non-obese (<29.9% Men <39.9% Women), and as sarcopenic based on a variant definition of the European Working Group on Sarcopenia in Older people (EWGSOP). Sarcopenia was defined as the lowest 20% of sex specific appendicular lean mass / height2. Subsequent cut points were 8.66kg/m2 for Males and 6.91kg/m2 for Female.ResultsThere was no significant difference between obese groups for Appendicular Lean Mass (ALM). ALM was however, significantly positively correlated with all DXA BMD measures including whole-body T-score (r = 0.416, p < 0.01), along with specific tibial and radial bone geometry. ALM was also positively correlated with hand grip strength (HGS) (r = 0.677, p <0.01) in older adults. HGS showed no differences between sarcopenia or obesity class. HGS was positively correlated with bone geometry at radial cortical bone area and thickness (r = 0.586, p <0.01 & r = 0.375, p < 0.01) sites. Whole-body T-score BMD was not significantly different between sarcopenia and obese groups. ConclusionLean mass measures are an important indication of strength measures in older adults. Moreover, lean mass and strength measures are significant determinants of whole-body BMD, and specific bone geometry aspects. Obesity or excess adiposity does not appear to have a significant impact on bone health, in older community dwelling adultsAbbreviationsATPAdenosine TriphosphateBMDBone Mineral DensityHGSHand Grip StrengthLESLeg Extension StrengthIMATIntramuscular Adipose TissueInterMATIntermuscular Adipose TissueCSACross Sectional AreaDXADual-energy X-ray AbsorptiometrypQCTperipheral Quantitative Computed TomographyIWGSInternational Working Group on SarcopeniaALMAppendicular Lean MassEWGSOPEuropean Working Group on Sarcopenia in Older PeopleBMIBody Mass IndexList of FiguresFigure 1.1 - Skeletal Muscle Fibre StructureFigure 1.2 – Skeletal Bone AnatomyFigure 1.3 – Bone Cell AnatomyFigure 3.1 – Foot placement of the progressive static balance testFigure 6.1 – Differences in appendicular lean mass between obese and sarcopenic groupsFigure 6.2 – Differences in gait speed between obese and sarcopenic groupsFigure 6.3 – Correlation between gait speed and average stair climb time in older adultsFigure 6.4 – Differences in hand grip strength between obese and sarcopenic groupsFigure 6.5 – Correlation between hand grip strength and whole-body DXA T-scoreFigure 6.6 – Differences in Leg extension strength between obese and sarcopenic groupsFigure 6.7 – Correlation of hand grip strength and leg extension strengthFigure 6.8 – Differences in whole-body DXA T-score between obese and sarcopenic groupsFigure 6.9 – Correlation between whole-body DXA T-scores and appendicular lean massList of Tables Table 1 – Sarcopenia incidence and definitions from; Gait Speed, Hand Grip Strength, IWGS, EWGSOP, EWGSOP according to Da Silva, and Total ALM according to Batsis Table 2 - Obesity definitions and incidence according to WHO BMI, Dufour et al. Total Body Fat Percentage (TBFP), and International Diabetes Federation (IDF) Waist CircumferenceTable 3 – Summary of key descriptive statistics in Table 4Table 3.1 – The correlation between appendicular lean mass with DXA BMD measures and specific bone geometryTable 3.2 – The correlation between hand grip strength and DXA derived bone density parametersTable 3.3 – Associations of whole-body DXA T-score with other bone health parametersAppendicesTable 4- Descriptive Statistics 2015 cohort (n=27)Table 5 – Descriptive statistics full cohort (n=65)Table 6 – Comparison of the 2013/14 to 2015 cohortTable 7 – Two Way MANOVA for Sarcopenia and Obesity groupsTable 8 – Full cohort bivariate analysis bone parametersTable 9 – Full cohort bivariate analysis muscle parametersTable 10 – Partial correlation adjusted for total body weight bone parametersTable 11 – Partial correlation adjusted for total body weight muscle parametersPatient Information and Consent FormData Collection BookletParticipant Record SheetQuestionnaireIntroduction1.1 Skeletal Muscle Structure & FunctionSkeletal muscle is a vital organ in the human body that contributes more than 50% to total body mass ADDIN EN.CITE <EndNote><Cite><Author>Cardinet III</Author><Year>1997</Year><RecNum>9</RecNum><DisplayText>(1)</DisplayText><record><rec-number>9</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453581">9</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cardinet III, George H</author></authors></contributors><titles><title>Skeletal muscle function</title><secondary-title>Clinical biochemistry of domestic animals</secondary-title></titles><periodical><full-title>Clinical biochemistry of domestic animals</full-title></periodical><pages>407-440</pages><volume>5</volume><dates><year>1997</year></dates><urls></urls></record></Cite></EndNote>(1), and is comprised of a large number of individual fibres bundled together. (Figure 1.1). The number of filaments bundled together is dependent upon the specific function of the individual muscle, with larger muscles such as the gastrocnemius of the lower leg, containing up to 10times the number of fibres than small ocular muscles ADDIN EN.CITE <EndNote><Cite><Author>Baltzopoulos</Author><Year>2001</Year><RecNum>3</RecNum><DisplayText>(2)</DisplayText><record><rec-number>3</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453575">3</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Baltzopoulos, Vasilios</author><author>Gleeson, Nigel P</author></authors></contributors><titles><title>Skeletal muscle function</title><secondary-title>Kinanthropometry and exercise physiology laboratory manual</secondary-title></titles><periodical><full-title>Kinanthropometry and exercise physiology laboratory manual</full-title></periodical><pages>1</pages><dates><year>2001</year></dates><urls></urls></record></Cite></EndNote>(2). Such quantities of muscle fibres allow for the performance of a multitude of functions; allowing for locomotion, skeletal support and posture, thermoregulation, soft tissue and organ support, and storage of nutrients ADDIN EN.CITE <EndNote><Cite><Author>Baltzopoulos</Author><Year>2001</Year><RecNum>3</RecNum><DisplayText>(2)</DisplayText><record><rec-number>3</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453575">3</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Baltzopoulos, Vasilios</author><author>Gleeson, Nigel P</author></authors></contributors><titles><title>Skeletal muscle function</title><secondary-title>Kinanthropometry and exercise physiology laboratory manual</secondary-title></titles><periodical><full-title>Kinanthropometry and exercise physiology laboratory manual</full-title></periodical><pages>1</pages><dates><year>2001</year></dates><urls></urls></record></Cite></EndNote>(2). Skeletal muscle is able to contract through the action of myosin and actin filaments within an individual unit known as the sarcomere. These two filaments have small areas that overlap, where myosin heads are able to attach to actin binding sites, and whose access is regulated by troponin and tropomyosin through the calcium ion mechanism (Figure 1.1) ADDIN EN.CITE <EndNote><Cite><Author>University College London</Author><Year>1997</Year><RecNum>112</RecNum><DisplayText>(3)</DisplayText><record><rec-number>112</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1431663728">112</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>University College London,</author></authors></contributors><titles><title>The Sliding Filament Theory</title></titles><volume>2015</volume><number>15/5/2015</number><dates><year>1997</year></dates><urls><related-urls><url>;(3). Through the use of adenosine triphosphate (ATP) the myosin heads are then able rotate and effectively pull/slide the actin filament over the myosin filament, drawing them closer together leading to a shortening of the sarcomere. This occurs within thousands of sarcomeres, in thousands of fibres, all relatively simultaneously, and the result is a contraction of muscles and subsequent movement.centercenter00320634170337Figure 1.1 The structure of Skeletal Muscle Fibre – taken from Cardinet III et al. ADDIN EN.CITE <EndNote><Cite><Author>Cardinet III</Author><Year>1997</Year><RecNum>9</RecNum><DisplayText>(1)</DisplayText><record><rec-number>9</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453581">9</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cardinet III, George H</author></authors></contributors><titles><title>Skeletal muscle function</title><secondary-title>Clinical biochemistry of domestic animals</secondary-title></titles><periodical><full-title>Clinical biochemistry of domestic animals</full-title></periodical><pages>407-440</pages><volume>5</volume><dates><year>1997</year></dates><urls></urls></record></Cite></EndNote>(1)020000Figure 1.1 The structure of Skeletal Muscle Fibre – taken from Cardinet III et al. ADDIN EN.CITE <EndNote><Cite><Author>Cardinet III</Author><Year>1997</Year><RecNum>9</RecNum><DisplayText>(1)</DisplayText><record><rec-number>9</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453581">9</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cardinet III, George H</author></authors></contributors><titles><title>Skeletal muscle function</title><secondary-title>Clinical biochemistry of domestic animals</secondary-title></titles><periodical><full-title>Clinical biochemistry of domestic animals</full-title></periodical><pages>407-440</pages><volume>5</volume><dates><year>1997</year></dates><urls></urls></record></Cite></EndNote>(1)The ability of muscle to contract and produce movement, the primary goal, is dependent on a wide range of factors including; nerve innervation ADDIN EN.CITE <EndNote><Cite><Author>Klass</Author><Year>2008</Year><RecNum>37</RecNum><DisplayText>(4)</DisplayText><record><rec-number>37</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453634">37</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Klass, Malgorzata</author><author>Baudry, Stéphane</author><author>Duchateau, Jacques</author></authors></contributors><titles><title>Age-related decline in rate of torque development is accompanied by lower maximal motor unit discharge frequency during fast contractions</title><secondary-title>Journal of Applied Physiology</secondary-title></titles><periodical><full-title>Journal of Applied Physiology</full-title></periodical><pages>739-746</pages><volume>104</volume><number>3</number><dates><year>2008</year></dates><isbn>8750-7587</isbn><urls><related-urls><url>;(4), protein synthesis or degradation ADDIN EN.CITE <EndNote><Cite><Author>Sorock</Author><Year>1992</Year><RecNum>78</RecNum><DisplayText>(5, 6)</DisplayText><record><rec-number>78</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430716930">78</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sorock, Gary S</author><author>Labiner, David M</author></authors></contributors><titles><title>Peripheral neuromuscular dysfunction and falls in an elderly cohort</title><secondary-title>American journal of epidemiology</secondary-title></titles><periodical><full-title>American journal of epidemiology</full-title></periodical><pages>584-591</pages><volume>136</volume><number>5</number><dates><year>1992</year></dates><isbn>0002-9262</isbn><urls><related-urls><url> app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453663">65</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Stevens, Jennifer E</author><author>Stackhouse, Scott K</author><author>Binder‐Macleod, Stuart A</author><author>Snyder‐Mackler, Lynn</author></authors></contributors><titles><title>Are voluntary muscle activation deficits in older adults meaningful?</title><secondary-title>Muscle & nerve</secondary-title></titles><periodical><full-title>Muscle & nerve</full-title></periodical><pages>99-101</pages><volume>27</volume><number>1</number><dates><year>2003</year></dates><isbn>1097-4598</isbn><urls></urls></record></Cite></EndNote>(5, 6), oxygenation and blood flow ADDIN EN.CITE <EndNote><Cite><Author>Martinez</Author><Year>2015</Year><RecNum>124</RecNum><DisplayText>(7, 8)</DisplayText><record><rec-number>124</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445074341">124</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Martinez, Bruno P</author><author>Batista, Anne KMS</author><author>Gomes, Isabela B</author><author>Olivieri, Flávia M</author><author>Camelier, Fernanda WR</author><author>Camelier, Aquiles A</author></authors></contributors><titles><title>Frequency of sarcopenia and associated factors among hospitalized elderly patients</title><secondary-title>BMC musculoskeletal disorders</secondary-title></titles><periodical><full-title>BMC musculoskeletal disorders</full-title></periodical><pages>108</pages><volume>16</volume><number>1</number><dates><year>2015</year></dates><isbn>1471-2474</isbn><urls></urls></record></Cite><Cite><Author>Yu</Author><Year>2015</Year><RecNum>141</RecNum><record><rec-number>141</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445079083">141</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Yu, Jie</author></authors></contributors><titles><title>The etiology and exercise implications of sarcopenia in the elderly</title><secondary-title>International Journal of Nursing Sciences</secondary-title></titles><periodical><full-title>International Journal of Nursing Sciences</full-title></periodical><dates><year>2015</year></dates><isbn>2352-0132</isbn><urls></urls></record></Cite></EndNote>(7, 8). These factors are however highly specific and multifaceted themselves. The broader areas however known to affect muscle function that must be recognised include; mass, strength ADDIN EN.CITE <EndNote><Cite><Author>Han</Author><Year>2015</Year><RecNum>125</RecNum><DisplayText>(9)</DisplayText><record><rec-number>125</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445074354">125</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Han, Peipei</author><author>Kang, Li</author><author>Guo, Qi</author><author>Wang, Jiazhong</author><author>Zhang, Wen</author><author>Shen, Suxing</author><author>Wang, Xiuyang</author><author>Dong, Renwei</author><author>Ma, Yixuan</author><author>Shi, Yu</author></authors></contributors><titles><title>Prevalence and Factors Associated With Sarcopenia in Suburb-dwelling Older Chinese Using the Asian Working Group for Sarcopenia Definition</title><secondary-title>The Journals of Gerontology Series A: Biological Sciences and Medical Sciences</secondary-title></titles><periodical><full-title>The Journals of Gerontology Series A: Biological Sciences and Medical Sciences</full-title></periodical><pages>glv108</pages><dates><year>2015</year></dates><isbn>1079-5006</isbn><urls></urls></record></Cite></EndNote>(9), fat mass or muscles adipose tissue content ADDIN EN.CITE <EndNote><Cite><Author>Tyrovolas</Author><Year>2015</Year><RecNum>123</RecNum><DisplayText>(10)</DisplayText><record><rec-number>123</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445074263">123</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Tyrovolas, Stefanos</author><author>Koyanagi, Ai</author><author>Olaya, Beatriz</author><author>Ayuso‐Mateos, Jose Luis</author><author>Miret, Marta</author><author>Chatterji, Somnath</author><author>Tobiasz‐Adamczyk, Beata</author><author>Koskinen, Seppo</author><author>Leonardi, Matilde</author><author>Haro, Josep Maria</author></authors></contributors><titles><title>Factors associated with skeletal muscle mass, sarcopenia, and sarcopenic obesity in older adults: a multi‐continent study</title><secondary-title>Journal of Cachexia, Sarcopenia and Muscle</secondary-title></titles><periodical><full-title>Journal of Cachexia, Sarcopenia and Muscle</full-title></periodical><dates><year>2015</year></dates><isbn>2190-6009</isbn><urls></urls></record></Cite></EndNote>(10). These factors together will be known as muscle quality throughout the remainder of this thesis.The term muscle quality, has been used in several publications as a suitable term to describe strength per unit of mass ADDIN EN.CITE <EndNote><Cite><Author>Park</Author><Year>2006</Year><RecNum>83</RecNum><DisplayText>(11)</DisplayText><record><rec-number>83</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430717620">83</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Park, Seok Won</author><author>Goodpaster, Bret H</author><author>Strotmeyer, Elsa S</author><author>de Rekeneire, Nathalie</author><author>Harris, Tamara B</author><author>Schwartz, Ann V</author><author>Tylavsky, Frances A</author><author>Newman, Anne B</author></authors></contributors><titles><title>Decreased muscle strength and quality in older adults with type 2 diabetes The Health, Aging, and Body Composition Study</title><secondary-title>Diabetes</secondary-title></titles><periodical><full-title>Diabetes</full-title></periodical><pages>1813-1818</pages><volume>55</volume><number>6</number><dates><year>2006</year></dates><isbn>0012-1797</isbn><urls><related-urls><url>;(11), or specific torque per unit of muscle area ADDIN EN.CITE <EndNote><Cite><Author>Conroy</Author><Year>2012</Year><RecNum>124</RecNum><DisplayText>(12)</DisplayText><record><rec-number>124</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1431987270">124</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Conroy, Molly B</author><author>Kwoh, C Kent</author><author>Krishnan, Eswar</author><author>Nevitt, Michael C</author><author>Boudreau, Robert</author><author>Carbone, Laura D</author><author>Chen, Hepei</author><author>Harris, Tamara B</author><author>Newman, Anne B</author><author>Goodpaster, Bret H</author></authors></contributors><titles><title>Muscle strength, mass, and quality in older men and women with knee osteoarthritis</title><secondary-title>Arthritis care & research</secondary-title></titles><periodical><full-title>Arthritis care & research</full-title></periodical><pages>15-21</pages><volume>64</volume><number>1</number><dates><year>2012</year></dates><isbn>2151-4658</isbn><urls></urls></record></Cite></EndNote>(12). Muscle function and inherent quality is a multifaceted and complex measure that is influenced by a multitude of factors, not only limited to those listed in the prior paragraph. Given the vital importance of muscle function in an individual’s day-to-day activity, poor muscle quality has the potential to have a significant negative impact. For example the loss of muscle function may lead to; decreasing mobility ADDIN EN.CITE <EndNote><Cite><Author>Metter</Author><Year>2002</Year><RecNum>46</RecNum><DisplayText>(13)</DisplayText><record><rec-number>46</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453642">46</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Metter, E Jeffrey</author><author>Talbot, Laura A</author><author>Schrager, Matthew</author><author>Conwit, Robin</author></authors></contributors><titles><title>Skeletal muscle strength as a predictor of all-cause mortality in healthy men</title><secondary-title>The Journals of Gerontology Series A: Biological Sciences and Medical Sciences</secondary-title></titles><periodical><full-title>The Journals of Gerontology Series A: Biological Sciences and Medical Sciences</full-title></periodical><pages>B359-B365</pages><volume>57</volume><number>10</number><dates><year>2002</year></dates><isbn>1079-5006</isbn><urls><related-urls><url>;(13), increased adipose tissue levels ADDIN EN.CITE <EndNote><Cite><Author>Roubenoff</Author><Year>2000</Year><RecNum>57</RecNum><DisplayText>(14)</DisplayText><record><rec-number>57</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453655">57</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Roubenoff, Ronenn</author></authors></contributors><titles><title>Sarcopenic Obesity: Does Muscle Loss Cause Fat Gain?: Lessons from Rheumatoid Arthritis and Osteoarthritisa</title><secondary-title>Annals of the New York Academy of Sciences</secondary-title></titles><periodical><full-title>Annals of the New York Academy of Sciences</full-title></periodical><pages>553-557</pages><volume>904</volume><number>1</number><dates><year>2000</year></dates><isbn>1749-6632</isbn><urls></urls></record></Cite></EndNote>(14), increased cardio-metabolic disease risk ADDIN EN.CITE <EndNote><Cite><Author>Scott</Author><Year>2014</Year><RecNum>59</RecNum><DisplayText>(15)</DisplayText><record><rec-number>59</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453657">59</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Scott, David</author><author>Sanders, Kerrie M</author><author>Aitken, Dawn</author><author>Hayes, Alan</author><author>Ebeling, Peter R</author><author>Jones, Graeme</author></authors></contributors><titles><title>Sarcopenic obesity and dynapenic obesity: 5‐year associations with falls risk in middle‐aged and older adults</title><secondary-title>Obesity</secondary-title></titles><periodical><full-title>Obesity</full-title></periodical><pages>1568-1574</pages><volume>22</volume><number>6</number><dates><year>2014</year></dates><isbn>1930-739X</isbn><urls><related-urls><url>;(15), decreased grip strength PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYXJ0aWVuPC9BdXRob3I+PFllYXI+MjAxNTwvWWVhcj48
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ADDIN EN.CITE.DATA (21-23). 1.2 Muscle Strength and MassMuscle mass, like muscle strength is vastly more complex than perhaps it gains credit for. Muscle mass hinges on many similar factors to that of muscle strength, incorporating dietary intake, protein synthesis and degradation rates, or vascular permeability to name a few PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Cb3VjaGFyZDwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+
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ADDIN EN.CITE.DATA (26, 35-38). Whilst much research has focused on the interaction of muscle mass and strength, some research has indicated mass may not be as significant indicator of strength as previously believed, especially in aging populations ADDIN EN.CITE <EndNote><Cite><Author>Reed</Author><Year>1991</Year><RecNum>51</RecNum><DisplayText>(39, 40)</DisplayText><record><rec-number>51</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453645">51</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Reed, RL</author><author>Pearlmutter, L</author><author>Yochum, K</author><author>Meredith, KE</author><author>Mooradian, AD</author></authors></contributors><titles><title>The relationship between muscle mass and muscle strength in the elderly</title><secondary-title>Journal of the American Geriatrics Society</secondary-title></titles><periodical><full-title>Journal of the American Geriatrics Society</full-title></periodical><pages>555-561</pages><volume>39</volume><number>6</number><dates><year>1991</year></dates><isbn>0002-8614</isbn><urls></urls></record></Cite><Cite><Author>Frontera</Author><Year>2000</Year><RecNum>26</RecNum><record><rec-number>26</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453612">26</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Frontera, Walter R</author><author>Hughes, Virginia A</author><author>Fielding, Roger A</author><author>Fiatarone, Maria A</author><author>Evans, William J</author><author>Roubenoff, Ronenn</author></authors></contributors><titles><title>Aging of skeletal muscle: a 12-yr longitudinal study</title><secondary-title>Journal of Applied Physiology</secondary-title></titles><periodical><full-title>Journal of Applied Physiology</full-title></periodical><pages>1321-1326</pages><volume>88</volume><number>4</number><dates><year>2000</year></dates><isbn>8750-7587</isbn><urls><related-urls><url>;(39, 40). Indeed there is evidence that with increasing age there is a disproportionate loss of muscle strength to that of mass. Given this, further investigation in order to clarify the relationship between muscle mass and strength, and there roles in physical function, and bone health within an aging population is warranted.1.3 Sarcopenia, Dynapenia and AgingThroughout aging there is a well-documented and perhaps unavoidable loss of muscle mass and strength ADDIN EN.CITE <EndNote><Cite><Author>Kim</Author><Year>2013</Year><RecNum>36</RecNum><DisplayText>(41, 42)</DisplayText><record><rec-number>36</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453634">36</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kim, Tae Nyun</author><author>Choi, Kyung Mook</author></authors></contributors><titles><title>Sarcopenia: Definition, Epidemiology, and Pathophysiology</title><secondary-title>Journal of Bone Metabolism</secondary-title></titles><periodical><full-title>Journal of Bone Metabolism</full-title></periodical><pages>1-10</pages><volume>20</volume><number>1</number><edition>May 13th 2013</edition><dates><year>2013</year></dates><urls><related-urls><url> app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445078891">140</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kahn, Arnold</author><author>Holm-Pedersen, Poul</author></authors></contributors><titles><title>Aging of bone and muscle</title><secondary-title>Textbook of Geriatric Dentistry</secondary-title></titles><periodical><full-title>Textbook of Geriatric Dentistry</full-title></periodical><pages>17</pages><dates><year>2015</year></dates><isbn>111890835X</isbn><urls></urls></record></Cite></EndNote>(41, 42), from as early as 40 years of age ADDIN EN.CITE <EndNote><Cite><Author>Morley</Author><Year>2001</Year><RecNum>144</RecNum><DisplayText>(43)</DisplayText><record><rec-number>144</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445080308">144</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Morley, John E</author><author>Baumgartner, Richard N</author><author>Roubenoff, Ronenn</author><author>Mayer, Jean</author><author>Nair, K Sreekumaran</author></authors></contributors><titles><title>Sarcopenia</title><secondary-title>Journal of Laboratory and Clinical Medicine</secondary-title></titles><periodical><full-title>Journal of Laboratory and Clinical Medicine</full-title></periodical><pages>231-243</pages><volume>137</volume><number>4</number><dates><year>2001</year></dates><isbn>0022-2143</isbn><urls><related-urls><url>(01)80110-4/abstract</url></related-urls></urls></record></Cite></EndNote>(43), but typically may only begin at the age of 60 or 65 ADDIN EN.CITE <EndNote><Cite><Author>Palmio</Author><Year>2014</Year><RecNum>142</RecNum><DisplayText>(44)</DisplayText><record><rec-number>142</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445079865">142</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Palmio, Johanna</author><author>Udd, Bjarne</author></authors></contributors><titles><title>Borderlines between sarcopenia and mild late-onset muscle disease</title><secondary-title>Frontiers in aging neuroscience</secondary-title></titles><periodical><full-title>Frontiers in aging neuroscience</full-title></periodical><volume>6</volume><dates><year>2014</year></dates><urls></urls></record></Cite></EndNote>(44). Indeed, individuals should expect to lose approximately 15% of their lean muscle mass from the age of 65 ADDIN EN.CITE <EndNote><Cite><Author>Hutchins</Author><Year>2014</Year><RecNum>145</RecNum><DisplayText>(45)</DisplayText><record><rec-number>145</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445081848">145</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>Hutchins, Alex</author></authors></contributors><titles><title>Is Age Related Muscle Loss Reversible</title></titles><volume>2015</volume><number>17/10/2015</number><dates><year>2014</year><pub-dates><date>25th February 2014</date></pub-dates></dates><publisher>Runners World</publisher><urls><related-urls><url>;(45). The loss of both skeletal muscle strength and mass as a result of aging was originally titled sarcopenia, meaning ‘poverty of flesh’ ADDIN EN.CITE <EndNote><Cite><Author>Rosenberg</Author><Year>1989</Year><RecNum>55</RecNum><DisplayText>(46)</DisplayText><record><rec-number>55</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453654">55</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rosenberg, IH</author></authors></contributors><titles><title>Summary comments</title><secondary-title>The American journal of clinical nutrition</secondary-title></titles><periodical><full-title>The American journal of clinical nutrition</full-title></periodical><pages>1231-1233</pages><volume>50</volume><dates><year>1989</year></dates><urls></urls></record></Cite></EndNote>(46). This term at the time was well conceived despite lacking a clear definition for the condition. In 2009, a symposium of research scientists and geriatricians founded the International working group on Sarcopenia (IWGS), defining sarcopenia as “…the age-associated loss of skeletal muscle mass and function”. Furthermore they noted that “Sarcopenia is a complex syndrome that is associated with muscle mass loss alone or in conjunction with increased fat mass”. In order to test for sarcopenia, the IWGS recommended testing for low appendicular lean mass (ALM) and low gait speed.The criticism of the term sarcopenia began almost immediately following its inception, yet did result in a number of other definitions and terms to describe the age related loss of muscle mass and strength, including the term ‘Dynapenia’ ADDIN EN.CITE <EndNote><Cite><Author>Clark</Author><Year>2008</Year><RecNum>13</RecNum><DisplayText>(47, 48)</DisplayText><record><rec-number>13</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453590">13</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Clark, Brian</author><author>Manini, Todd</author></authors></contributors><titles><title>Sarcopenia =/= Dynapenia</title><secondary-title>Journals of Gerontology</secondary-title></titles><periodical><full-title>Journals of Gerontology</full-title></periodical><pages>829-834</pages><volume>63</volume><number>8</number><dates><year>2008</year></dates><urls><related-urls><url> app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453594">15</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Clark, Brian </author><author>Manini, Todd </author></authors></contributors><titles><title>What is dynapenia?</title><secondary-title>Nutrition</secondary-title></titles><periodical><full-title>Nutrition</full-title></periodical><pages>495-503</pages><volume>28</volume><number>5</number><dates><year>2012</year></dates><isbn>0899-9007</isbn><urls><related-urls><url>;(47, 48). Dynapenia relates specifically to the loss of muscle strength throughout aging that is independent of changes in muscle mass PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Hb29kcGFzdGVyPC9BdXRob3I+PFllYXI+MjAwNjwvWWVh
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ADDIN EN.CITE.DATA (51, 52). The EWGSOP definition, involves measuring not only ALM and gait speed, but also hand grip strength. This is similar to studies by Goodpaster et al. (2006) and Delmonico et al. (2007) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5EZWxtb25pY288L0F1dGhvcj48WWVhcj4yMDA3PC9ZZWFy
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ADDIN EN.CITE.DATA (26, 53). Thus in order to be diagnosed as sarcopenic by the EWGSOP definition, a person must have low ALM, combined with either of; low skeletal muscle strength or low grip strength.The definition of sarcopenia provided by the EWGSOP has been recently criticized as an overly simplistic interpretation of a complex, multifaceted phenomenon, with too greater emphasis on the loss of muscle mass ADDIN EN.CITE <EndNote><Cite><Author>Kim</Author><Year>2013</Year><RecNum>36</RecNum><DisplayText>(41)</DisplayText><record><rec-number>36</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453634">36</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kim, Tae Nyun</author><author>Choi, Kyung Mook</author></authors></contributors><titles><title>Sarcopenia: Definition, Epidemiology, and Pathophysiology</title><secondary-title>Journal of Bone Metabolism</secondary-title></titles><periodical><full-title>Journal of Bone Metabolism</full-title></periodical><pages>1-10</pages><volume>20</volume><number>1</number><edition>May 13th 2013</edition><dates><year>2013</year></dates><urls><related-urls><url>;(41) ADDIN EN.CITE <EndNote><Cite><Author>Clark</Author><Year>2008</Year><RecNum>13</RecNum><DisplayText>(47)</DisplayText><record><rec-number>13</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453590">13</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Clark, Brian</author><author>Manini, Todd</author></authors></contributors><titles><title>Sarcopenia =/= Dynapenia</title><secondary-title>Journals of Gerontology</secondary-title></titles><periodical><full-title>Journals of Gerontology</full-title></periodical><pages>829-834</pages><volume>63</volume><number>8</number><dates><year>2008</year></dates><urls><related-urls><url>;(47). The reason for this focus on skeletal muscle mass arose from evidence indicating that skeletal muscle mass and skeletal muscle strength are causally linked PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Gcm9udGVyYTwvQXV0aG9yPjxZZWFyPjIwMDA8L1llYXI+
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ADDIN EN.CITE.DATA (54-57) it is this term which will be applied throughout the course of this thesis.1.4 Mechanisms of SarcopeniaThe factors contributing to sarcopenia have been summarised into two broad categories; neural factors and muscle factors ADDIN EN.CITE <EndNote><Cite><Author>Clark</Author><Year>2012</Year><RecNum>15</RecNum><DisplayText>(48)</DisplayText><record><rec-number>15</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453594">15</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Clark, Brian </author><author>Manini, Todd </author></authors></contributors><titles><title>What is dynapenia?</title><secondary-title>Nutrition</secondary-title></titles><periodical><full-title>Nutrition</full-title></periodical><pages>495-503</pages><volume>28</volume><number>5</number><dates><year>2012</year></dates><isbn>0899-9007</isbn><urls><related-urls><url>;(48). A decrease in neural stimulation may arise from a range of sources including; decreased motor unit recruitment, action potential inhibition, and possible neuromuscular junction failure ADDIN EN.CITE <EndNote><Cite><Author>Clark</Author><Year>2010</Year><RecNum>14</RecNum><DisplayText>(49)</DisplayText><record><rec-number>14</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453591">14</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Clark, Brian</author><author>Manini, Todd</author></authors></contributors><titles><title>Functional Consequences of Sarcopenia and Dynapenia in the Elderly</title><secondary-title>Curent Opinion in Clinical Nutritional and Metabolic Care</secondary-title></titles><periodical><full-title>Curent Opinion in Clinical Nutritional and Metabolic Care</full-title></periodical><pages>271-276</pages><volume>13</volume><number>3</number><dates><year>2010</year></dates><urls></urls></record></Cite></EndNote>(49). Muscular factors that may contribute to the loss of muscle mass and strength loss include; muscle fibre atrophy, myosin-actin cross bridging failure, an increase in Intramuscular adipose tissue (IMAT) infiltration ADDIN EN.CITE <EndNote><Cite><Author>Clark</Author><Year>2010</Year><RecNum>14</RecNum><DisplayText>(49)</DisplayText><record><rec-number>14</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453591">14</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Clark, Brian</author><author>Manini, Todd</author></authors></contributors><titles><title>Functional Consequences of Sarcopenia and Dynapenia in the Elderly</title><secondary-title>Curent Opinion in Clinical Nutritional and Metabolic Care</secondary-title></titles><periodical><full-title>Curent Opinion in Clinical Nutritional and Metabolic Care</full-title></periodical><pages>271-276</pages><volume>13</volume><number>3</number><dates><year>2010</year></dates><urls></urls></record></Cite></EndNote>(49) or changes in rates of protein synthesis and degradation ADDIN EN.CITE <EndNote><Cite><Author>Moore</Author><Year>2015</Year><RecNum>151</RecNum><DisplayText>(58)</DisplayText><record><rec-number>151</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445084252">151</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Moore, Daniel R</author><author>Churchward-Venne, Tyler A</author><author>Witard, Oliver</author><author>Breen, Leigh</author><author>Burd, Nicholas A</author><author>Tipton, Kevin D</author><author>Phillips, Stuart M</author></authors></contributors><titles><title>Protein ingestion to stimulate myofibrillar protein synthesis requires greater relative protein intakes in healthy older versus younger men</title><secondary-title>The Journals of Gerontology Series A: Biological Sciences and Medical Sciences</secondary-title></titles><periodical><full-title>The Journals of Gerontology Series A: Biological Sciences and Medical Sciences</full-title></periodical><pages>57-62</pages><volume>70</volume><number>1</number><dates><year>2015</year></dates><isbn>1079-5006</isbn><urls><related-urls><url>;(58). The exact contribution of each factor involved in sarcopenia is difficult to ascertain, and little is known about the importance of each aspect. Sarcopenia is also reported in individuals who exhibit decreased caloric or protein intake, or in those with decreased physical activity levels ADDIN EN.CITE <EndNote><Cite><Author>Goodpaster</Author><Year>2008</Year><RecNum>28</RecNum><DisplayText>(59)</DisplayText><record><rec-number>28</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453617">28</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Goodpaster, Bret H</author><author>Chomentowski, Peter</author><author>Ward, Bryan K</author><author>Rossi, Andrea</author><author>Glynn, Nancy W</author><author>Delmonico, Matthew J</author><author>Kritchevsky, Stephen B</author><author>Pahor, Marco</author><author>Newman, Anne B</author></authors></contributors><titles><title>Effects of physical activity on strength and skeletal muscle fat infiltration in older adults: a randomized controlled trial</title><secondary-title>Journal of Applied Physiology</secondary-title></titles><periodical><full-title>Journal of Applied Physiology</full-title></periodical><pages>1498-1503</pages><volume>105</volume><number>5</number><dates><year>2008</year></dates><isbn>8750-7587</isbn><urls><related-urls><url>;(59). The mechanisms of sarcopenia are particularly difficult to determine due to their seemingly idiopathic nature in many instances, but one major contributing factor may be excess adiposity, or obesity ADDIN EN.CITE <EndNote><Cite><Author>Evans</Author><Year>2008</Year><RecNum>152</RecNum><DisplayText>(60)</DisplayText><record><rec-number>152</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445084311">152</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Evans, William J</author><author>Morley, John E</author><author>Argilés, Josep</author><author>Bales, Connie</author><author>Baracos, Vickie</author><author>Guttridge, Denis</author><author>Jatoi, Aminah</author><author>Kalantar-Zadeh, Kamyar</author><author>Lochs, Herbert</author><author>Mantovani, Giovanni</author></authors></contributors><titles><title>Cachexia: a new definition</title><secondary-title>Clinical nutrition</secondary-title></titles><periodical><full-title>Clinical Nutrition</full-title></periodical><pages>793-799</pages><volume>27</volume><number>6</number><dates><year>2008</year></dates><isbn>0261-5614</isbn><urls><related-urls><url>(08)00113-1/abstract</url></related-urls></urls></record></Cite></EndNote>(60).1.5 Sarcopenia and Obesity SynergismGiven the intricate nature of sarcopenia, inter-related medical conditions should be expected. Coronary heart disease, metabolic syndrome, osteoarthritis, hypertension or diabetes amongst others may even be caused by sarcopenia, and further exacerbated alongside obesity ADDIN EN.CITE <EndNote><Cite><Author>Booth</Author><Year>2012</Year><RecNum>110</RecNum><DisplayText>(61, 62)</DisplayText><record><rec-number>110</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1431604466">110</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Booth, Frank W</author><author>Roberts, Christian K</author><author>Laye, Matthew J</author></authors></contributors><titles><title>Lack of exercise is a major cause of chronic diseases</title><secondary-title>Comprehensive Physiology</secondary-title></titles><periodical><full-title>Comprehensive Physiology</full-title></periodical><dates><year>2012</year></dates><isbn>0470650710</isbn><urls></urls></record></Cite><Cite><Author>Daniels</Author><Year>2006</Year><RecNum>109</RecNum><record><rec-number>109</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1431603564">109</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Daniels, Stephen R</author></authors></contributors><titles><title>The consequences of childhood overweight and obesity</title><secondary-title>The future of children</secondary-title></titles><periodical><full-title>The future of children</full-title></periodical><pages>47-67</pages><volume>16</volume><number>1</number><dates><year>2006</year></dates><isbn>1550-1558</isbn><urls></urls></record></Cite></EndNote>(61, 62) ADDIN EN.CITE <EndNote><Cite><Author>Meng</Author><Year>2014</Year><RecNum>128</RecNum><DisplayText>(63, 64)</DisplayText><record><rec-number>128</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1431996269">128</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Meng, P</author><author>Hu, Y X</author><author>Fan, L</author><author>Zhang, Y</author><author>Zhang, M X</author><author>Sun, J</author><author>Liu, Y</author><author>Li, M</author><author>Yang, Y</author><author>Wang, L H</author></authors></contributors><titles><title>Sarcopenia and sarcopenic obesity among men aged 80 years and older in Beijing: Prevalence and its association with functional performance</title><secondary-title>Geriatrics & gerontology international</secondary-title></titles><periodical><full-title>Geriatrics & gerontology international</full-title></periodical><pages>29-35</pages><volume>14</volume><number>S1</number><dates><year>2014</year></dates><isbn>1447-0594</isbn><urls></urls></record></Cite><Cite><Author>Sénéchal</Author><Year>2012</Year><RecNum>60</RecNum><record><rec-number>60</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453659">60</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sénéchal, M</author><author>Dione, IJ</author><author>Brochu, M</author></authors></contributors><titles><title>Dynapenic abdominal obesity and Metabolic risk factors in Adults 50 years of age and older</title><secondary-title>Journal of Aging Health</secondary-title></titles><periodical><full-title>Journal of Aging Health</full-title></periodical><pages>812-826</pages><volume>24</volume><number>5</number><edition>March 26th 2012</edition><dates><year>2012</year></dates><urls><related-urls><url>;(63, 64). Scott et al. (2014) recently examined the potential additive effects of sarcopenia with obesity and their impact upon falls risk ADDIN EN.CITE <EndNote><Cite><Author>Scott</Author><Year>2014</Year><RecNum>59</RecNum><DisplayText>(15)</DisplayText><record><rec-number>59</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453657">59</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Scott, David</author><author>Sanders, Kerrie M</author><author>Aitken, Dawn</author><author>Hayes, Alan</author><author>Ebeling, Peter R</author><author>Jones, Graeme</author></authors></contributors><titles><title>Sarcopenic obesity and dynapenic obesity: 5‐year associations with falls risk in middle‐aged and older adults</title><secondary-title>Obesity</secondary-title></titles><periodical><full-title>Obesity</full-title></periodical><pages>1568-1574</pages><volume>22</volume><number>6</number><dates><year>2014</year></dates><isbn>1930-739X</isbn><urls><related-urls><url>;(15). The results of this study showed that there was a significant increase in the risk for falls and fractures in those participants with both sarcopenia and obesity, compared to those with either condition independently. This finding was particularly important as it highlighted the combined impact that the conditions have upon musculoskeletal health. It did however, confuse the notion that obesity alone may be protective against fractures ADDIN EN.CITE <EndNote><Cite><Author>Scott</Author><Year>2013</Year><RecNum>58</RecNum><DisplayText>(65)</DisplayText><record><rec-number>58</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453655">58</key></foreign-keys><ref-type name="Personal Communication">26</ref-type><contributors><authors><author>Scott, David</author><author>Ebeling, Peter</author></authors></contributors><titles><title>Dynapenic Obesity, Muscoloskeletal and Cardiometabolic Health in Older Adults</title></titles><dates><year>2013</year><pub-dates><date>12/5/2014</date></pub-dates></dates><publisher>Australian Institute for Muscolskeletal Science; The University of Melbourne
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ADDIN EN.CITE.DATA (73-75) for the classification of obesity, however with increasing availability of accurate body compositional assessment tools such as dual energy x-ray absorptiometry (DXA) or peripheral quantitative computed tomography (pQCT) ADDIN EN.CITE <EndNote><Cite><Author>Leonard</Author><Year>2009</Year><RecNum>39</RecNum><DisplayText>(76)</DisplayText><record><rec-number>39</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453637">39</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Leonard, CherylM</author><author>Roza, MelissaA</author><author>Barr, RonaldD</author><author>Webber, ColinE</author></authors></contributors><titles><title>Reproducibility of DXA measurements of bone mineral density and body composition in children</title><secondary-title>Pediatric Radiology</secondary-title><alt-title>Pediatr Radiol</alt-title></titles><periodical><full-title>Pediatric Radiology</full-title><abbr-1>Pediatr Radiol</abbr-1></periodical><alt-periodical><full-title>Pediatric Radiology</full-title><abbr-1>Pediatr Radiol</abbr-1></alt-periodical><pages>148-154</pages><volume>39</volume><number>2</number><keywords><keyword>Dual photon absorptiometry</keyword><keyword>Bone mineral density</keyword><keyword>Body composition</keyword><keyword>Reproducibility</keyword></keywords><dates><year>2009</year><pub-dates><date>2009/02/01</date></pub-dates></dates><publisher>Springer-Verlag</publisher><isbn>0301-0449</isbn><urls><related-urls><url>*~hmac=f00d2d3033af1697aa90185c832e48662b095bb6f7ebe5765866a46256246876</url></related-urls></urls><electronic-resource-num>10.1007/s00247-008-1067-7</electronic-resource-num><language>English</language></record></Cite></EndNote>(76) differential diagnoses are beginning to be used. For example, Dufour et al. (2012) and others have introduced total body fat percentage cut off points to diagnose obesity PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5ab2ljbzwvQXV0aG9yPjxZZWFyPjIwMDQ8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (77-83). Specifically Dufour et al’s cut off points are derived from a DXA scan, and have seen widespread usage preferentially to BMI due to a greater specificity, and onus placed upon adipose mass ADDIN EN.CITE <EndNote><Cite><Author>Maggi</Author><Year>2015</Year><RecNum>157</RecNum><DisplayText>(73)</DisplayText><record><rec-number>157</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445084940">157</key></foreign-keys><ref-type name="Book Section">5</ref-type><contributors><authors><author>Maggi, Stefania</author><author>Busetto, Luca</author><author>Noale, Marianna</author><author>Limongi, Federica</author><author>Crepaldi, Gaetano</author></authors></contributors><titles><title>Obesity: Definition and Epidemiology</title><secondary-title>Multidisciplinary Approach to Obesity</secondary-title></titles><pages>31-39</pages><dates><year>2015</year></dates><publisher>Springer</publisher><isbn>3319090445</isbn><urls></urls></record></Cite></EndNote>(73) instead of body mass, independent of its composition, and height. Furthermore, BMI may be greatly overestimated in individuals with higher levels of lean mass, thereby providing an inaccurate reflection of their body composition. Estimated body fat percentage has also seen widespread usage PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5SYWhtYW48L0F1dGhvcj48WWVhcj4yMDEwPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (82-84) where a DXA scan has not been readily available.1.6 Sarcopenia and Adipose Interactions with Osseous TissueBones provide the structure for our bodies, in the same way as muscle provides the frame work for our physical structure, whilst also allowing for; locomotion, nutrient storage, tissue support, posture and soft tissue protection ADDIN EN.CITE <EndNote><Cite><Author>Carter</Author><Year>2007</Year><RecNum>162</RecNum><DisplayText>(85, 86)</DisplayText><record><rec-number>162</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445085858">162</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Carter, Dennis R</author><author>Beaupré, Gary S</author></authors></contributors><titles><title>Skeletal function and form: mechanobiology of skeletal development, aging, and regeneration</title></titles><dates><year>2007</year></dates><publisher>Cambridge University Press</publisher><isbn>0521714753</isbn><urls></urls></record></Cite><Cite><Author>Rodan</Author><Year>2003</Year><RecNum>163</RecNum><record><rec-number>163</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445085927">163</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rodan, Gideon A</author></authors></contributors><titles><title>The development and function of the skeleton and bone metastases</title><secondary-title>Cancer</secondary-title></titles><periodical><full-title>Cancer</full-title></periodical><pages>726-732</pages><volume>97</volume><number>S3</number><dates><year>2003</year></dates><isbn>1097-0142</isbn><urls></urls></record></Cite></EndNote>(85, 86). It is a complex system regulated by hormones, minerals and osteocyte cell activity PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CdWNrd2FsdGVyPC9BdXRob3I+PFllYXI+MTk4NjwvWWVh
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ADDIN EN.CITE.DATA (87-89). Osteoclast and Osteoblast cells are constantly monitored by the mature bone cells; osteocytes, and are responsible for the laying down, or removing of osseous tissue. An individual’s bone mineral density (BMD) or bone strength is there for highly reliant upon the activity of these cells. An excess of osteoclast activity (bone removal) will result in a lower bone mineral density, and weakened bone ADDIN EN.CITE <EndNote><Cite><Author>Erlebacher</Author><Year>1996</Year><RecNum>122</RecNum><DisplayText>(89)</DisplayText><record><rec-number>122</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1431735302">122</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Erlebacher, Adrian</author><author>Derynck, Rik</author></authors></contributors><titles><title>Increased expression of TGF-beta 2 in osteoblasts results in an osteoporosis-like phenotype</title><secondary-title>The Journal of cell biology</secondary-title></titles><periodical><full-title>The Journal of cell biology</full-title></periodical><pages>195-210</pages><volume>132</volume><number>1</number><dates><year>1996</year></dates><isbn>0021-9525</isbn><urls></urls></record></Cite></EndNote>(89). Figure 1.2. Skeletal Bone Anatomy – Taken from McGraw Hill ADDIN EN.CITE <EndNote><Cite><Author>Companies</Author><Year>2011</Year><RecNum>224</RecNum><DisplayText>(90)</DisplayText><record><rec-number>224</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1446119855">224</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>The McGraw-Hill Companies,</author></authors></contributors><titles><title>Bone Structure</title></titles><pages>Bone Micro-structure</pages><volume>2015</volume><number>29/10/2015</number><dates><year>2011</year></dates><urls><related-urls><url>;(90)Figure 1.3. Bone cell anatomy – Taken from Boundless ADDIN EN.CITE <EndNote><Cite><Author>Boundless</Author><Year>2015</Year><RecNum>225</RecNum><DisplayText>(91)</DisplayText><record><rec-number>225</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1446120377">225</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>Boundless</author></authors></contributors><titles><title>Cell Types in Bones</title><secondary-title>Boundless Biology</secondary-title></titles><pages>Cell Types in Bones</pages><volume>2015</volume><number>29/10/2015</number><dates><year>2015</year><pub-dates><date>21/7/2015</date></pub-dates></dates><publisher>Boundless</publisher><urls><related-urls><url>;(91)BMD is just a small part of the overall bone health picture, however, with factors such as cortical bone area and thickness, endosteal circumference, or strength strain index; otherwise known as bone geometry, also playing a notable role PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CYXJib3VyPC9BdXRob3I+PFllYXI+MjAxMDwvWWVhcj48
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ADDIN EN.CITE.DATA (98-102), a negative impact on obesity ADDIN EN.CITE <EndNote><Cite><Author>Lee</Author><Year>2014</Year><RecNum>169</RecNum><DisplayText>(103, 104)</DisplayText><record><rec-number>169</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445087644">169</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lee, I-Min</author><author>Sesso, Howard D</author><author>Chen, Jin-Jong</author><author>Paffenbarger Jr, Ralph S</author></authors></contributors><titles><title>Does physical activity play a role in the prevention of prostate cancer?</title><secondary-title>Epidemiologic reviews</secondary-title></titles><periodical><full-title>Epidemiologic reviews</full-title></periodical><pages>132-7</pages><volume>23</volume><number>1</number><dates><year>2014</year></dates><urls></urls></record></Cite><Cite><Author>DeLany</Author><Year>2014</Year><RecNum>170</RecNum><record><rec-number>170</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445087664">170</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>DeLany, James P</author><author>Kelley, David E</author><author>Hames, Kazanna C</author><author>Jakicic, John M</author><author>Goodpaster, Bret H</author></authors></contributors><titles><title>Effect of physical activity on weight loss, energy expenditure, and energy intake during diet induced weight loss</title><secondary-title>Obesity</secondary-title></titles><periodical><full-title>Obesity</full-title></periodical><pages>363-370</pages><volume>22</volume><number>2</number><dates><year>2014</year></dates><isbn>1930-739X</isbn><urls><related-urls><url>;(103, 104), overall adiposity, IMAT and Intermuscular adipose tissue (InterMAT) levels ADDIN EN.CITE <EndNote><Cite><Author>Maddocks</Author><Year>2014</Year><RecNum>171</RecNum><DisplayText>(105, 106)</DisplayText><record><rec-number>171</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445088249">171</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Maddocks, Matthew</author><author>Shrikrishna, Dinesh</author><author>Vitoriano, Simone</author><author>Natanek, Samantha A</author><author>Tanner, Rebecca J</author><author>Hart, Nicholas</author><author>Kemp, Paul R</author><author>Moxham, John</author><author>Polkey, Michael I</author><author>Hopkinson, Nicholas S</author></authors></contributors><titles><title>Skeletal muscle adiposity is associated with physical activity, exercise capacity and fibre shift in COPD</title><secondary-title>European Respiratory Journal</secondary-title></titles><periodical><full-title>European Respiratory Journal</full-title></periodical><pages>1188-1198</pages><volume>44</volume><number>5</number><dates><year>2014</year></dates><isbn>0903-1936</isbn><urls><related-urls><url> app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445088288">172</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Addison, Odessa</author><author>Marcus, Robin L</author><author>LaStayo, Paul C</author><author>Ryan, Alice S</author></authors></contributors><titles><title>Intermuscular fat: a review of the consequences and causes</title><secondary-title>International journal of endocrinology</secondary-title></titles><periodical><full-title>International journal of endocrinology</full-title></periodical><volume>2014</volume><dates><year>2014</year></dates><isbn>1687-8337</isbn><urls></urls></record></Cite></EndNote>(105, 106) thus improving general physical function in older adults ADDIN EN.CITE <EndNote><Cite><Author>Therkelsen</Author><Year>2015</Year><RecNum>173</RecNum><DisplayText>(107)</DisplayText><record><rec-number>173</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445088311">173</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Therkelsen, Kate E</author><author>Pedley, Alison</author><author>Hoffman, Udo</author><author>Fox, Caroline</author><author>Murabito, Joanne</author></authors></contributors><titles><title>Abstract MP77: Intramuscular Fat is Associated with Decreased Physical Performance</title><secondary-title>Circulation</secondary-title></titles><periodical><full-title>Circulation</full-title></periodical><pages>AMP77-AMP77</pages><volume>131</volume><number>Suppl 1</number><dates><year>2015</year></dates><isbn>0009-7322</isbn><urls></urls></record></Cite></EndNote>(107). Additionally moderate PA has also been shown to reduce incidence ADDIN EN.CITE <EndNote><Cite><Author>Liu</Author><Year>2014</Year><RecNum>175</RecNum><DisplayText>(108)</DisplayText><record><rec-number>175</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445093034">175</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Liu, Christine K</author><author>Leng, Xiaoyan</author><author>Hsu, F-C</author><author>Kritchevsky, SB</author><author>Ding, J</author><author>Earnest, CP</author><author>Ferrucci, L</author><author>Goodpaster, BH</author><author>Guralnik, JM</author><author>Lenchik, L</author></authors></contributors><titles><title>The impact of sarcopenia on a physical activity intervention: the Lifestyle Interventions and Independence for Elders Pilot Study (LIFE-P)</title><secondary-title>The journal of nutrition, health & aging</secondary-title></titles><periodical><full-title>The journal of nutrition, health & aging</full-title></periodical><pages>59-64</pages><volume>18</volume><number>1</number><dates><year>2014</year></dates><isbn>1279-7707</isbn><urls></urls></record></Cite></EndNote>(108), or at least severity of sarcopenia ADDIN EN.CITE <EndNote><Cite><Author>Cvecka</Author><Year>2015</Year><RecNum>174</RecNum><DisplayText>(109)</DisplayText><record><rec-number>174</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445092837">174</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cvecka, Jan</author><author>Tirpakova, Veronika</author><author>Sedliak, Milan</author><author>Kern, Helmut</author><author>Mayr, Winfried</author><author>Hamar, Du?an</author></authors></contributors><titles><title>Physical activity in elderly</title><secondary-title>European Journal of Translational Myology</secondary-title></titles><periodical><full-title>European Journal of Translational Myology</full-title></periodical><pages>249-252</pages><volume>25</volume><number>4</number><dates><year>2015</year></dates><isbn>2037-7460</isbn><urls></urls></record></Cite></EndNote>(109). 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ADDIN EN.CITE.DATA (123, 124). Adiponectin also has the potential to have a great impact on bone metabolism. For instance, Shinoda et al. (2006) demonstrated that adiponectin affected bone formation and metabolism, and subsequent BMD, specifically through osteoclast activity and bone metabolism in mice ADDIN EN.CITE <EndNote><Cite><Author>Shinoda</Author><Year>2006</Year><RecNum>101</RecNum><DisplayText>(125)</DisplayText><record><rec-number>101</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430783790">101</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Shinoda, Yusuke</author><author>Yamaguchi, Masayuki</author><author>Ogata, Naoshi</author><author>Akune, Toru</author><author>Kubota, Naoto</author><author>Yamauchi, Toshimasa</author><author>Terauchi, Yasuo</author><author>Kadowaki, Takashi</author><author>Takeuchi, Yasuhiro</author><author>Fukumoto, Seiji</author></authors></contributors><titles><title>Regulation of bone formation by adiponectin through autocrine/paracrine and endocrine pathways</title><secondary-title>Journal of cellular biochemistry</secondary-title></titles><periodical><full-title>Journal of cellular biochemistry</full-title></periodical><pages>196-208</pages><volume>99</volume><number>1</number><dates><year>2006</year></dates><isbn>1097-4644</isbn><urls><related-urls><url>;(125). Adiponectin’s influence however is not well understood, with some research indicating that adiponectin may increase bone metabolism, and reduce BMD values ADDIN EN.CITE <EndNote><Cite><Author>Amemiya</Author><Year>2013</Year><RecNum>218</RecNum><DisplayText>(126)</DisplayText><record><rec-number>218</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445860627">218</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Amemiya, Nobuyuki</author><author>Otsubo, Shigeru</author><author>Iwasa, Yuko</author><author>Onuki, Takako</author><author>Nitta, Kosaku</author></authors></contributors><titles><title>Association between high-molecular-weight adiponectin and bone mineral density in hemodialysis patients</title><secondary-title>Clinical and experimental nephrology</secondary-title></titles><periodical><full-title>Clinical and experimental nephrology</full-title></periodical><pages>411-415</pages><volume>17</volume><number>3</number><dates><year>2013</year></dates><isbn>1342-1751</isbn><urls></urls></record></Cite></EndNote>(126). The relative impact that these adipokines have on BMD may however be less significant than suspected, with the influence of increased adiposity, subsequent body mass, and increased load bearing upon BMD being well documented in both animal and human models PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CZXZpZXI8L0F1dGhvcj48WWVhcj4xOTg5PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (112-114).1.7 RationaleThe independent effects of the factors involved in sarcopenia, have been well investigated, with greater strength associated with greater bone health. Lean mass has also shown to have a significant impact upon bone health. Obesity alone too has been well correlated with greater BMD and bone geometry through a multitude of pathways. However, little research has been conducted gauging the impact of low levels of strength and mass, when seen in combination with obesity on bone health and physical function in an older adult population. It is hoped that further research will produce clinically applicable results, providing quantitative evidence that clinicians should consider the impact that sarcopenia and obesity may have upon bone health and physical function in older adults. Furthermore it is hoped that research will support the development of intervention techniques aimed at increasing strength and lean mass, whilst simultaneously decreasing adiposity, in order to potentially improve the bone health, and overall physical function of older individuals.Aim and Hypotheses2.1 AimsIn this cross sectional study of community dwelling older adults, we aim to:Observe the impact of overweight and obesity upon the musculoskeletal and cardio metabolic health of adults over the age of 50. Determine the association between sarcopenia and obesity upon physical strength and bone mineral density2.2 HypothesesMuscle mass and strength will be positively correlated with each other irrespective of obesity statusSarcopenia will be correlated with lower bone healthObesity will be correlated will greater bone health3. Methods3.1 Participant Recruitment and EligibilityData from the study was collected at Sunshine Hospital within the Western Centre for Health, Research and Education (WCHRE). A total of 27 participants were recruited for the study in 2015, generating a total of 67 through the course of the study (2013-current) (HREC 2013.294). Participants were recruited from the surrounding suburbs of Sunshine Hospital in the North Western suburbs of Metropolitan Melbourne, through hospital clinics, local general practices, universities and local community organisations such as Rotary International, gymnasiums such as Curves Women’s Gym, and community centres such as the Sydenham community centre.Once participants expressed interest in taking part in the research project they were contacted by telephone and screened for initial eligibility before an appointment was organised to attend the WCHRE. In addition to screening participants, nominated general practitioners were contacted in order to confirm an individual’s eligibility and suitability for the study.All participants attended Sunshine Hospital between the hours of 8am and 1pm for data collection, providing written informed consent at the time of appointment. The study has approval from both Melbourne Health (2013.294) and Western Health (HREC/13/MH/397) ethical committees.Inclusion Criteria:The inclusion criteria for the study is as follows≥ 50 years of ageBMI ≥ 25kg/m2 or have been told they are overweight by a medical professionalCommunity dwellingExclusion Criteria:Participants were excluded if they met any of the following criteriaReside in an aged-care facilityWeight exceeding 150kg. Take a Vitamin D supplement ≥ 400IU a day.Are unable to walk across a room unaided.Are currently or have participated in a structured exercise regime targeted at weight loss or building muscular strength in the last 3 months.Are currently or are trying to fall pregnant.Have any history of any neurological disorder, including but not limited to;Parkinson’s DiseaseMultiple SclerosisBipolar DisorderSchizophreniaExperience any severe joint pain such as arthritis, or are awaiting a joint replacementAny condition that may interfere with the ability to complete functional testingHave had a lung disease requiring the use of corticosteroids or supplemental oxygen (Asthma excluded).Renal disease or failure requiring dialysisHistory of Stroke.Hip or Knee replacement, Spinal surgery, major heart surgery or myocardial infarction within the past 6 months. Any other medical condition that may limit life expectancy to <12months.3.2 Clinical TestingParticipants involved in the study attended the WCHRE at Sunshine Hospital for a one off appointment which lasted up to 3 hours. Blood Sampling:Participants began the morning appointment with a fasting blood test performed by Dorevitch Pathology staff at Sunshine Hospital. The specifics of blood tests conducted in the protocol can be viewed in the appendices. The DiaSorin LIAISON (DiaSorin Inc, Stillwater, MN, USA) chemiluminescent immunoassay (CLIA) quantified serum 25OHD using specific antibodies, co-specific for 25-hydoxyvitamin D2 and 25-hydroxyvitamin D3 ADDIN EN.CITE <EndNote><Cite><Author>DiaSorin</Author><Year>2013</Year><RecNum>75</RecNum><DisplayText>(127)</DisplayText><record><rec-number>75</rec-number><foreign-keys><key app="EN" db-id="epzvswrawe2w9se0wf85rap22r9z2etrffrt" timestamp="1409896451">75</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>DiaSorin</author></authors></contributors><auth-address>1951 Northwestern Ave- Stillwater, MN USA</auth-address><titles><title>LIAISON 25 OH Vitamin D TOTAL Assay </title></titles><pages>1-9</pages><dates><year>2013</year></dates><work-type>Instruction manual</work-type><urls></urls></record></Cite></EndNote>(127). The assay has a dynamic range from 10nmol/L to 375nmol/L, and a coefficient of variation (CV) of <15%. Glucose levels were analysed using the ADVIA Chemistry Glucose Hexokinase 3 assay (Siemens Healthcare Diagnostics Incorporation, Bayswater, Australia), with a CV of <2% ADDIN EN.CITE <EndNote><Cite><Author>Siemens</Author><Year>2012</Year><RecNum>79</RecNum><DisplayText>(128)</DisplayText><record><rec-number>79</rec-number><foreign-keys><key app="EN" db-id="epzvswrawe2w9se0wf85rap22r9z2etrffrt" timestamp="1410138725">79</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Siemens</author></authors><secondary-authors><author>Siemens Healthcare Diagnostics Incorporation </author></secondary-authors></contributors><titles><title>Glucose Hexokinase_3 (GLUH_3)</title></titles><dates><year>2012</year></dates><urls></urls></record></Cite></EndNote>(128). The ADVIA Chemistry Systems assays also analysed concentrated levels cholesterol and triglycerides ADDIN EN.CITE <EndNote><Cite><Author>Siemens</Author><Year>2011</Year><RecNum>83</RecNum><DisplayText>(129)</DisplayText><record><rec-number>83</rec-number><foreign-keys><key app="EN" db-id="epzvswrawe2w9se0wf85rap22r9z2etrffrt" timestamp="1410146744">83</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Siemens</author></authors></contributors><titles><title>Triglycerides</title></titles><dates><year>2011</year></dates><urls></urls></record></Cite></EndNote>(129). CVs for total cholesterol and triglycerides are reported by the manufacturers to be <2% and <4%, respectively ADDIN EN.CITE <EndNote><Cite><Author>Siemens</Author><Year>2011</Year><RecNum>83</RecNum><DisplayText>(129)</DisplayText><record><rec-number>83</rec-number><foreign-keys><key app="EN" db-id="epzvswrawe2w9se0wf85rap22r9z2etrffrt" timestamp="1410146744">83</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Siemens</author></authors></contributors><titles><title>Triglycerides</title></titles><dates><year>2011</year></dates><urls></urls></record></Cite></EndNote>(129). A latex enhanced immunoturbudimetric assay quantitatively determined serum C-Reactive Protein (CRP) concentration, a marker of inflammatory disorders (including infection and tissue injuries) ADDIN EN.CITE <EndNote><Cite><Author>Siemens</Author><Year>2011</Year><RecNum>84</RecNum><DisplayText>(130)</DisplayText><record><rec-number>84</rec-number><foreign-keys><key app="EN" db-id="epzvswrawe2w9se0wf85rap22r9z2etrffrt" timestamp="1410147450">84</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Siemens</author></authors></contributors><titles><title>Wide Range C-Reactive Protein</title></titles><dates><year>2011</year></dates><urls></urls></record></Cite></EndNote>(130), using the ADVIA Chemistry System. The manufacturer specifies a CV of <8% for this assay ADDIN EN.CITE <EndNote><Cite><Author>Siemens</Author><Year>2011</Year><RecNum>84</RecNum><DisplayText>(130)</DisplayText><record><rec-number>84</rec-number><foreign-keys><key app="EN" db-id="epzvswrawe2w9se0wf85rap22r9z2etrffrt" timestamp="1410147450">84</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Siemens</author></authors></contributors><titles><title>Wide Range C-Reactive Protein</title></titles><dates><year>2011</year></dates><urls></urls></record></Cite></EndNote>(130). Serum insulin concentration was analysed by a commercial solid-phase, enzyme-labelled chemiluminescentimmunometric assay (IMMULITE 2000 Insulin, Siemens, Bayswater, Australia) which has sensitivity of 2?IU/mL.These measurements provide us with a generalised picture of the individual’s health, along with systemic metabolite levels. Further calculation using the Glucose and Insulin measures enables the generation a homeostatic model for insulin resistance (HOMA-IR) which provides a value corresponding to the risk of developing type 2 diabetes mellitus (T2DM) – an important figure for clinical diagnosis and treatment of individuals ADDIN EN.CITE <EndNote><Cite><Author>González‐Gay</Author><Year>2015</Year><RecNum>137</RecNum><DisplayText>(131, 132)</DisplayText><record><rec-number>137</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1438839026">137</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>González‐Gay, Miguel A</author><author>Llorca, Javier</author><author>González‐Juanatey, Carlos</author><author>Dessein, Patrick H</author></authors></contributors><titles><title>Is the homeostatic model assessment of insulin resistance (HOMA‐IR) a poor predictor of cardiovascular disease in rheumatoid arthritis?</title><secondary-title>Arthritis & Rheumatology</secondary-title></titles><periodical><full-title>Arthritis & Rheumatology</full-title></periodical><dates><year>2015</year></dates><isbn>2326-5205</isbn><urls></urls></record></Cite><Cite><Author>Shaban</Author><Year>2014</Year><RecNum>138</RecNum><record><rec-number>138</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1438839131">138</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Shaban, N</author><author>Kenno, KA</author><author>Milne, KJ</author></authors></contributors><titles><title>The effects of a 2 week modified high intensity interval training program on the homeostatic model of insulin resistance (HOMA-IR) in adults with type 2 diabetes</title><secondary-title>The Journal of sports medicine and physical fitness</secondary-title></titles><periodical><full-title>The Journal of sports medicine and physical fitness</full-title></periodical><pages>203-209</pages><volume>54</volume><number>2</number><dates><year>2014</year></dates><isbn>0022-4707</isbn><urls></urls></record></Cite></EndNote>(131, 132).Anthropometry:Following the blood test participants underwent various anthropometric measurements including; height, weight (consequent BMI is noted), waist and hip circumference. Blood pressure was also recorded with the use of the digital blood pressure cuff (Omron HEM-907 IntelliSense). Two measures were taken with a one minute interval, with a subsequent third taken if a difference of more than 25mmHg or 15mmHg was noted for systolic and diastolic pressure respectively within each reading. Height was measured to the nearest 1mm using a wall mounted stadiometer (Seca 222, Seca, Hamburg, Germany). Weight was measured to the nearest 0.1kg through the use of electronic scales (Seca 804, Seca, Hamburg, Germany). Waist and hip circumference were also measured to the nearest 1mm, with the average of two readings recorded. Waist measurements were made at the mid-point between the inferior margin of the final rib and crest of the ileum ADDIN EN.CITE <EndNote><Cite><Author>Shaw</Author><Year>2007</Year><RecNum>144</RecNum><DisplayText>(133, 134)</DisplayText><record><rec-number>144</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1439359384">144</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Shaw, KA</author><author>Srikanth, VK</author><author>Fryer, JL</author><author>Blizzard, L</author><author>Dwyer, Terry</author><author>Venn, AJ</author></authors></contributors><titles><title>Dual energy X-ray absorptiometry body composition and aging in a population-based older cohort</title><secondary-title>International journal of obesity</secondary-title></titles><periodical><full-title>International journal of obesity</full-title></periodical><pages>279-284</pages><volume>31</volume><number>2</number><dates><year>2007</year></dates><isbn>0307-0565</isbn><urls><related-urls><url> Expert Consultation</Author><Year>2011</Year><RecNum>145</RecNum><record><rec-number>145</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1439359440">145</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>WHO Expert Consultation,</author></authors></contributors><titles><title>Waist circumference and waist-hip ratio</title></titles><dates><year>2011</year><pub-dates><date>08/11/2008</date></pub-dates></dates><urls></urls><access-date>12/08/2015</access-date></record></Cite></EndNote>(133, 134) whilst hip circumference was measured at the level of the greatest protrusion of the buttocks. The measurements allow for different modes of classification or participants - using BMI through height and weight as outlined in the original study protocol (WHO) ADDIN EN.CITE <EndNote><Cite><Author>WHO</Author><Year>2015</Year><RecNum>72</RecNum><DisplayText>(65, 74)</DisplayText><record><rec-number>72</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453668">72</key></foreign-keys><ref-type name="Web Page">12</ref-type><contributors><authors><author>WHO</author></authors></contributors><titles><title>Obesity and Overweight</title></titles><volume>2015</volume><number>13/04/2015</number><dates><year>2015</year><pub-dates><date>January 2015</date></pub-dates></dates><pub-location>World Health Organisation Media Centre</pub-location><urls><related-urls><url> app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453655">58</key></foreign-keys><ref-type name="Personal Communication">26</ref-type><contributors><authors><author>Scott, David</author><author>Ebeling, Peter</author></authors></contributors><titles><title>Dynapenic Obesity, Muscoloskeletal and Cardiometabolic Health in Older Adults</title></titles><dates><year>2013</year><pub-dates><date>12/5/2014</date></pub-dates></dates><publisher>Australian Institute for Muscolskeletal Science; The University of Melbourne
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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5OaWV0by1HYXJjaWE8L0F1dGhvcj48WWVhcj4xOTkwPC9Z
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ADDIN EN.CITE.DATA (138, 139) however the respective questionnaires were chosen for inclusion as they all have been independently demonstrated as a viable tool in providing quantitative data concerning broader health aspects of participants - there within: The CDC Healthy days questionnaire ADDIN EN.CITE <EndNote><Cite><Author>Dominick</Author><Year>2002</Year><RecNum>140</RecNum><DisplayText>(140)</DisplayText><record><rec-number>140</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1439352185">140</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Dominick, Kelli L</author><author>Ahern, Frank M</author><author>Gold, Carol H</author><author>Heller, Debra A</author></authors></contributors><titles><title>Relationship of health-related quality of life to health care utilization and mortality among older adults</title><secondary-title>Aging clinical and experimental research</secondary-title></titles><periodical><full-title>Aging clinical and experimental research</full-title></periodical><pages>499-508</pages><volume>14</volume><number>6</number><dates><year>2002</year></dates><isbn>1594-0667</isbn><urls></urls></record></Cite></EndNote>(140), Active Australia Survey ADDIN EN.CITE <EndNote><Cite><Author>Brown</Author><Year>2008</Year><RecNum>7</RecNum><DisplayText>(141)</DisplayText><record><rec-number>7</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453579">7</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Brown, Wendy J</author><author>Burton, Nicola W</author><author>Marshall, Alison L</author><author>Miller, Yvette D</author></authors></contributors><titles><title>Reliability and validity of a modified self‐administered version of the Active Australia physical activity survey in a sample of mid‐age women</title><secondary-title>Australian and New Zealand journal of public health</secondary-title></titles><periodical><full-title>Australian and New Zealand journal of public health</full-title></periodical><pages>535-541</pages><volume>32</volume><number>6</number><dates><year>2008</year></dates><isbn>1753-6405</isbn><urls><related-urls><url>;(141), Sunlight exposure questionnaire ADDIN EN.CITE <EndNote><Cite><Author>Cargill</Author><Year>2013</Year><RecNum>10</RecNum><DisplayText>(142)</DisplayText><record><rec-number>10</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453583">10</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cargill, Jessica</author><author>Lucas, Robyn M</author><author>Gies, Peter</author><author>King, Kerryn</author><author>Swaminathan, Ashwin</author><author>Allen, Martin W</author><author>Banks, Emily</author></authors></contributors><titles><title>Validation of brief questionnaire measures of sun exposure and skin pigmentation against detailed and objective measures including vitamin D status</title><secondary-title>Photochemistry and photobiology</secondary-title></titles><periodical><full-title>Photochemistry and photobiology</full-title></periodical><pages>219-226</pages><volume>89</volume><number>1</number><dates><year>2013</year></dates><isbn>1751-1097</isbn><urls><related-urls><url>;(142), EuroQol 5D ADDIN EN.CITE <EndNote><Cite><Author>Slater</Author><Year>1994</Year><RecNum>62</RecNum><DisplayText>(143)</DisplayText><record><rec-number>62</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453660">62</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Slater, Carl H</author><author>Bick, Dawn</author></authors></contributors><titles><title>Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation</title><secondary-title>JAMA</secondary-title></titles><periodical><full-title>JAMA</full-title></periodical><pages>1377-1377</pages><volume>271</volume><number>17</number><dates><year>1994</year></dates><isbn>0098-7484</isbn><urls></urls></record></Cite></EndNote>(143), AQol-6D ADDIN EN.CITE <EndNote><Cite><Author>Osborne</Author><Year>2003</Year><RecNum>49</RecNum><DisplayText>(144)</DisplayText><record><rec-number>49</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453644">49</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Osborne, Richard H</author><author>Hawthorne, Graeme</author><author>Lew, Elizabeth A</author><author>Gray, Len C</author></authors></contributors><titles><title>Quality of life assessment in the community-dwelling elderly: validation of the Assessment of Quality of Life (AQoL) Instrument and comparison with the SF-36</title><secondary-title>Journal of clinical epidemiology</secondary-title></titles><periodical><full-title>Journal of clinical epidemiology</full-title></periodical><pages>138-147</pages><volume>56</volume><number>2</number><dates><year>2003</year></dates><isbn>0895-4356</isbn><urls><related-urls><url>;(144) and the modified falls efficacy scale (MFES) were all completed by participants. 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ADDIN EN.CITE.DATA (145-148) an important factor given the multicultural nature of participants involved in the study positional Analysis:DXA AnalysisParticipants then underwent a full body scan using Dual Energy X-ray Absorptiometry (DXA). The scan provides a two-dimensional representation of the individual, allowing visualisation of adipose tissue localisations, lean muscle and skeletal bone mass. Participants are scanned in a supine position (Hologic Discovery W, Hologic, USA) and transverse scans are performed at 1cm intervals taking between 7-8 minutes per whole body scan. All scans were conducted and analysed by a qualified densitometrist, following protocols as outlined by the International Society for Clinical Densitometry. The DXA machine was calibrated daily through the use of a supplied skeletal spine phantom. The skeletal bone data obtained from the DXA scan also provides areal BMD across the entire body. These values are important as they provide a reference point for diagnosis of Osteopenia, Osteoporosis and other bone density issues through the use of the World Health Organisations (WHO) accepted T-scores ADDIN EN.CITE <EndNote><Cite><Author>WHO</Author><Year>2004</Year><RecNum>71</RecNum><DisplayText>(149)</DisplayText><record><rec-number>71</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453667">71</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>WHO</author></authors><secondary-authors><author>World Health Organisation</author></secondary-authors></contributors><titles><title>WHO Scientific Group on the Assessment of Osteoporosis at Primary Health Care Level</title></titles><dates><year>2004</year><pub-dates><date>5-7/5/2004</date></pub-dates></dates><pub-location>Belgium, Brussels</pub-location><urls></urls></record></Cite></EndNote>(149). Osteopenia was seen as between -1 and -2.4 SD below a reference norm. Osteoporosis was classed as a T-score of < - 2.5 SD below the same reference norm, through the use of the World Health Organisation (WHO) guidelines ADDIN EN.CITE <EndNote><Cite><Author>WHO</Author><Year>2004</Year><RecNum>71</RecNum><DisplayText>(149)</DisplayText><record><rec-number>71</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453667">71</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>WHO</author></authors><secondary-authors><author>World Health Organisation</author></secondary-authors></contributors><titles><title>WHO Scientific Group on the Assessment of Osteoporosis at Primary Health Care Level</title></titles><dates><year>2004</year><pub-dates><date>5-7/5/2004</date></pub-dates></dates><pub-location>Belgium, Brussels</pub-location><urls></urls></record></Cite></EndNote>(149).DXA scan holds many advantages over other comparable techniques such as bio-impedance analysis, due to its accuracy and reproducibility PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CbGFrZTwvQXV0aG9yPjxZZWFyPjIwMDc8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (76, 150, 151). The particular machine at the CHRE has shown <3% variation in identical samples. Furthermore DXA scans also have low levels of radiation (0.05millisievert [mSV]), short scan times and simple calibration ADDIN EN.CITE <EndNote><Cite><Author>Leonard</Author><Year>2009</Year><RecNum>39</RecNum><DisplayText>(76)</DisplayText><record><rec-number>39</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453637">39</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Leonard, CherylM</author><author>Roza, MelissaA</author><author>Barr, RonaldD</author><author>Webber, ColinE</author></authors></contributors><titles><title>Reproducibility of DXA measurements of bone mineral density and body composition in children</title><secondary-title>Pediatric Radiology</secondary-title><alt-title>Pediatr Radiol</alt-title></titles><periodical><full-title>Pediatric Radiology</full-title><abbr-1>Pediatr Radiol</abbr-1></periodical><alt-periodical><full-title>Pediatric Radiology</full-title><abbr-1>Pediatr Radiol</abbr-1></alt-periodical><pages>148-154</pages><volume>39</volume><number>2</number><keywords><keyword>Dual photon absorptiometry</keyword><keyword>Bone mineral density</keyword><keyword>Body composition</keyword><keyword>Reproducibility</keyword></keywords><dates><year>2009</year><pub-dates><date>2009/02/01</date></pub-dates></dates><publisher>Springer-Verlag</publisher><isbn>0301-0449</isbn><urls><related-urls><url>*~hmac=f00d2d3033af1697aa90185c832e48662b095bb6f7ebe5765866a46256246876</url></related-urls></urls><electronic-resource-num>10.1007/s00247-008-1067-7</electronic-resource-num><language>English</language></record></Cite></EndNote>(76). However as DXA does only provide a two-dimensional image it can consequently underestimate volumetric BMD, and provide an overestimation of an individual’ trabecular bone density and inherent strength due to cortical shielding ADDIN EN.CITE <EndNote><Cite><Author>Dowthwaite</Author><Year>2011</Year><RecNum>22</RecNum><DisplayText>(151, 152)</DisplayText><record><rec-number>22</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453605">22</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Dowthwaite, Jodi Noelle</author><author>Flowers, Portia PE</author><author>Scerpella, Tamara Ann</author></authors></contributors><titles><title>Agreement between pQCT‐and DXA‐derived indices of bone geometry, density, and theoretical strength in females of varying age, maturity, and physical activity</title><secondary-title>Journal of Bone and Mineral Research</secondary-title></titles><periodical><full-title>Journal of Bone and Mineral Research</full-title></periodical><pages>1349-1357</pages><volume>26</volume><number>6</number><dates><year>2011</year></dates><isbn>1523-4681</isbn><urls><related-urls><url> app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453638">40</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Li, Na</author><author>Li, Xin-min</author><author>Xu, Li</author><author>Sun, Wei-jie</author><author>Cheng, Xiao-guang</author><author>Tian, Wei</author></authors></contributors><titles><title>Comparison of QCT and DXA: osteoporosis detection rates in postmenopausal women</title><secondary-title>International journal of endocrinology</secondary-title></titles><periodical><full-title>International journal of endocrinology</full-title></periodical><volume>2013</volume><dates><year>2013</year></dates><isbn>1687-8337</isbn><urls></urls></record></Cite></EndNote>(151, 152), an area shown to be important in fracture prevention ADDIN EN.CITE <EndNote><Cite><Author>Gnudi</Author><Year>2014</Year><RecNum>168</RecNum><DisplayText>(97)</DisplayText><record><rec-number>168</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445087249">168</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gnudi, S</author><author>Sitta, E</author><author>Fiumi, N</author></authors></contributors><titles><title>Bone density and geometry in assessing hip fracture risk in post-menopausal women</title><secondary-title>The British journal of radiology</secondary-title></titles><periodical><full-title>The British journal of radiology</full-title></periodical><dates><year>2014</year></dates><urls></urls></record></Cite></EndNote>(97). Peripheral Quantitative Computed Tomography Peripheral Quantitative Computed Tomography (pQCT) is highly valuable as it addresses the several shortcomings of the DXA scan, by providing a three-dimensional volumetric image of the participants appendages, differentiating the cortical and trabecular bone ADDIN EN.CITE <EndNote><Cite><Author>Muller</Author><Year>1989</Year><RecNum>133</RecNum><DisplayText>(153)</DisplayText><record><rec-number>133</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1435212548">133</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Muller, Armin</author><author>Ruegsegger, Emmi</author><author>Ruegsegger, Peter</author></authors></contributors><titles><title>Peripheral QCT: a low-risk procedure to identify women predisposed to osteoporosis</title><secondary-title>Physics in medicine and biology</secondary-title></titles><periodical><full-title>Physics in medicine and biology</full-title></periodical><pages>741</pages><volume>34</volume><number>6</number><dates><year>1989</year></dates><isbn>0031-9155</isbn><urls><related-urls><url>;(153). Measures were taken at both proximal (66%) and distal (4%) sites in the radius and tibia. These locations have been demonstrated in previous publications to show the smallest degree of variability in bone geometry values ADDIN EN.CITE <EndNote><Cite><Author>Kontulainen</Author><Year>2008</Year><RecNum>142</RecNum><DisplayText>(154)</DisplayText><record><rec-number>142</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1439355140">142</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kontulainen, SA</author><author>Johnston, JD</author><author>Liu, D</author><author>Leung, C</author><author>Oxland, TR</author><author>McKay, HA</author></authors></contributors><titles><title>Strength indices from pQCT imaging predict up to 85% of variance in bone failure properties at tibial epiphysis and diaphysis</title><secondary-title>J Musculoskelet Neuronal Interact</secondary-title></titles><periodical><full-title>J Musculoskelet Neuronal Interact</full-title></periodical><pages>401-9</pages><volume>8</volume><number>4</number><dates><year>2008</year></dates><urls></urls></record></Cite></EndNote>(154). Moreover pQCT provides us with a volumetric bone mineral density T-score which is far more specified for diagnosis of osteoporosis at particular sites as the value pertains to the specific area of bone under investigation ADDIN EN.CITE <EndNote><Cite><Author>Kontulainen</Author><Year>2008</Year><RecNum>19</RecNum><DisplayText>(154)</DisplayText><record><rec-number>19</rec-number><foreign-keys><key app="EN" db-id="axfrdfsx3txzvueddatx0fvx0prwx9sadfrt" timestamp="1445758737">19</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kontulainen, SA</author><author>Johnston, JD</author><author>Liu, D</author><author>Leung, C</author><author>Oxland, TR</author><author>McKay, HA</author></authors></contributors><titles><title>Strength indices from pQCT imaging predict up to 85% of variance in bone failure properties at tibial epiphysis and diaphysis</title><secondary-title>J Musculoskelet Neuronal Interact</secondary-title></titles><pages>401-9</pages><volume>8</volume><number>4</number><dates><year>2008</year></dates><urls></urls></record></Cite></EndNote>(154). 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The combinatory use of both the DXA and pQCT scan is not uncommon as research has noted reproducible and agreeable indices between the machines ADDIN EN.CITE <EndNote><Cite><Author>Li</Author><Year>2013</Year><RecNum>40</RecNum><DisplayText>(151, 152)</DisplayText><record><rec-number>40</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453638">40</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Li, Na</author><author>Li, Xin-min</author><author>Xu, Li</author><author>Sun, Wei-jie</author><author>Cheng, Xiao-guang</author><author>Tian, Wei</author></authors></contributors><titles><title>Comparison of QCT and DXA: osteoporosis detection rates in postmenopausal women</title><secondary-title>International journal of endocrinology</secondary-title></titles><periodical><full-title>International journal of endocrinology</full-title></periodical><volume>2013</volume><dates><year>2013</year></dates><isbn>1687-8337</isbn><urls></urls></record></Cite><Cite><Author>Dowthwaite</Author><Year>2011</Year><RecNum>22</RecNum><record><rec-number>22</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453605">22</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Dowthwaite, Jodi Noelle</author><author>Flowers, Portia PE</author><author>Scerpella, Tamara Ann</author></authors></contributors><titles><title>Agreement between pQCT‐and DXA‐derived indices of bone geometry, density, and theoretical strength in females of varying age, maturity, and physical activity</title><secondary-title>Journal of Bone and Mineral Research</secondary-title></titles><periodical><full-title>Journal of Bone and Mineral Research</full-title></periodical><pages>1349-1357</pages><volume>26</volume><number>6</number><dates><year>2011</year></dates><isbn>1523-4681</isbn><urls><related-urls><url>;(151, 152). The pQCT was calibrated daily with the use of the manufacturers phantom, with CV for this study at 0.2% at trabecular volumetric BMD.pQCT AnalysisImages generated by the pQCT scan were analysed with the use of the manufacturer’s standard software (version 6.2). At 66% (proximal) sites the threshold of 710mg/cm3 was used to separate cortical from trabecular bone. Along with cortical bone thickness, area and density at the proximal tibia and radius, periosteal circumference (perimeter of tibia), endosteal circumference (internal perimeter of cortical area), and polar strength-strain index were also generated. The CV for radial trabecular and tibial cortical volumetric BMD were 0.9% and 0.2%, respectively. Subcutaneous fat was removed from analysis at both proximal tibia and radius sites by applying an outer threshold of 40mg/cm3. Muscle CSA (mm2) and muscle density (mg/cm3) were determined via manufacturer algorithms. Muscle density acts as a proxy for muscle fat infiltration, or IMAT, with low values representing greater infiltration. In order to distinguish InterMAT, an inner threshold of 15mg/mm was applied, in order to isolate adipose tissue within muscle compartments. Bone marrow fat was then subtracted in order to calculate the remaining InterMAT. This protocol has demonstrated excellent precision, with CV’s of 4% and 1% for InterMAT and muscle CSA, respectively.Strength Assessment and Short Physical Performance BatteryWrist and HGS is measured through the use of a Jamar hydraulic handgrip dynamometer (Patterson Medical, Warrenville, IL, USA), with participants performing three trials on each hand, with an average of the final two values of each hand recorded. The dynamometer is held at a 90° angle to the individual, parallel to the ground and the participant is asked to grip with their maximum force. The Jamar dynamometer is considered the gold standard and has a been used extensively ADDIN EN.CITE <EndNote><Cite><Author>Roberts</Author><Year>2011</Year><RecNum>141</RecNum><DisplayText>(158)</DisplayText><record><rec-number>141</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1439354078">141</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Roberts, Helen C</author><author>Denison, Hayley J</author><author>Martin, Helen J</author><author>Patel, Harnish P</author><author>Syddall, Holly</author><author>Cooper, Cyrus</author><author>Sayer, Avan Aihie</author></authors></contributors><titles><title>A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach</title><secondary-title>Age and ageing</secondary-title></titles><periodical><full-title>Age and Ageing</full-title></periodical><pages>afr051</pages><dates><year>2011</year></dates><isbn>0002-0729</isbn><urls></urls></record></Cite></EndNote>(158), with an intraclass CV for the trials of 0.99.Low hand grip strength was defined according to the EWGSOP definition, of <20kg for Females, and <30kg for Males ADDIN EN.CITE <EndNote><Cite><Author>Cruz-Jentoft</Author><Year>2010</Year><RecNum>18</RecNum><DisplayText>(51)</DisplayText><record><rec-number>18</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453600">18</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cruz-Jentoft, AJ</author><author>Baeyens, JP</author><author>Bauer, JM</author><author>Boirie, Y</author><author>Cederholm, T</author><author>Landi, F</author><author>Martin, FC</author><author>Michel, JP</author><author>Rolland, Y</author><author>Schneider, SM</author><author>Topinkova, E</author><author>Vandewoude, M</author><author>Zamboni, M</author></authors></contributors><titles><title>Sarcopenia: European consensus on definition and diagnosis</title><secondary-title>Age Aging</secondary-title></titles><periodical><full-title>Age Aging</full-title></periodical><pages>412-423</pages><volume>39</volume><number>4</number><edition>April 13th 2010</edition><dates><year>2010</year></dates><urls></urls></record></Cite></EndNote>(51).Lower limb strength was also assessed using a handheld dynamometer (Lafayette Manual Muscle Tester, Model 01165, Lafeyette Instrument Company, Lafeyette, IN, USA), in the form of a leg extension test. The dynamometer is positioned on the participant’s lower tibia approximately 10cm superior to the ankle joint. An investigator kneels in front of the participant, holding the dynamometer in place whilst the participant is asked to extend their leg as forcefully as possible along the extensor plane of their lower leg. The investigator holds both the dynamometer and the participant’s lower leg in place through counter balancing force, allowing for all force generated to be recorded by the dynamometer provided the participants leg remains in an isometric contraction. Participants were asked to ensure their hands remain on their lap, and their upper body did not move into a partially reclined position thereby allowing for greater force generation. The intraclass CV of the trials was 0.98.Gait speed was assessed through the use of a 2.44m (8feet) measured track. Participants were asked to walk at a comfortable speed, with timing begun as the first foot leaves the ground, and cease once their final leg crosses the finishing line. Participants completed the test once. The distance of 2.44m has been repeatedly shown as a simple measure of gait speed, that is easily implemented, and an accurate measure of an older individuals self-selected gait speed ADDIN EN.CITE <EndNote><Cite><Author>Lang</Author><Year>2008</Year><RecNum>216</RecNum><DisplayText>(159, 160)</DisplayText><record><rec-number>216</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445759289">216</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lang, Iain A</author><author>Llewellyn, David J</author><author>Alexander, Kirsty</author><author>Melzer, David</author></authors></contributors><titles><title>Obesity, physical function, and mortality in older adults</title><secondary-title>Journal of the American Geriatrics Society</secondary-title></titles><periodical><full-title>Journal of the American Geriatrics Society</full-title></periodical><pages>1474-1478</pages><volume>56</volume><number>8</number><dates><year>2008</year></dates><isbn>1532-5415</isbn><urls></urls></record></Cite><Cite><Author>Rogers</Author><Year>2003</Year><RecNum>215</RecNum><record><rec-number>215</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445759277">215</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rogers, Michael E</author><author>Rogers, Nicole L</author><author>Takeshima, Nobuo</author><author>Islam, Mohammod M</author></authors></contributors><titles><title>Methods to assess and improve the physical parameters associated with fall risk in older adults</title><secondary-title>Preventive medicine</secondary-title></titles><periodical><full-title>Preventive medicine</full-title></periodical><pages>255-264</pages><volume>36</volume><number>3</number><dates><year>2003</year></dates><isbn>0091-7435</isbn><urls></urls></record></Cite></EndNote>(159, 160). Gait speed has also been shown to independently associate with an increased risk of mortality at a 7 year follow up study ADDIN EN.CITE <EndNote><Cite><Author>Ostir</Author><Year>2007</Year><RecNum>217</RecNum><DisplayText>(161)</DisplayText><record><rec-number>217</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445759420">217</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ostir, Glenn V</author><author>Kuo, Yong-Fang</author><author>Berges, Ivonne M</author><author>Markides, Kyriakos S</author><author>Ottenbacher, Kenneth J</author></authors></contributors><titles><title>Measures of lower body function and risk of mortality over 7 years of follow-up</title><secondary-title>American journal of epidemiology</secondary-title></titles><periodical><full-title>American journal of epidemiology</full-title></periodical><pages>599-605</pages><volume>166</volume><number>5</number><dates><year>2007</year></dates><isbn>0002-9262</isbn><urls></urls></record></Cite></EndNote>(161). A low gait speed was regarded as <0.8m/s as defined by Cruz-Jentoft et al. ADDIN EN.CITE <EndNote><Cite><Author>Cruz-Jentoft</Author><Year>2010</Year><RecNum>18</RecNum><DisplayText>(51)</DisplayText><record><rec-number>18</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453600">18</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cruz-Jentoft, AJ</author><author>Baeyens, JP</author><author>Bauer, JM</author><author>Boirie, Y</author><author>Cederholm, T</author><author>Landi, F</author><author>Martin, FC</author><author>Michel, JP</author><author>Rolland, Y</author><author>Schneider, SM</author><author>Topinkova, E</author><author>Vandewoude, M</author><author>Zamboni, M</author></authors></contributors><titles><title>Sarcopenia: European consensus on definition and diagnosis</title><secondary-title>Age Aging</secondary-title></titles><periodical><full-title>Age Aging</full-title></periodical><pages>412-423</pages><volume>39</volume><number>4</number><edition>April 13th 2010</edition><dates><year>2010</year></dates><urls></urls></record></Cite></EndNote>(51)The sit to stand test comprised of participant rising from a seated position, to standing straight and returning to seating 5 times as quickly as possible. Participants crossed their hands across their chest in order to negate the use of their hands. A score was given to participant based on their time of completion. Full scoring criterion can be seen in appendix 10.The stair climb assessment involves participants climb a flight of 10 steps. The 10 steps rise to 1.73m, and participants scaled the stairs twice, with the mean of two attempts taken. Timing began from the point at which their first foot leaves the ground, stopping after their second foot reaches the top step. The flight of stairs is adjoined by a rail and participants are encouraged to hold the rail for balance if they feel necessary. Stair climb force (F) was subsequently calculated, as the participants mass multiplied by gravitation resistance (9.88m/s2). Work was then calculated as Force multiplied by distance (1.73m). Stair climb power is synonymous with Work.Balance Assessment:Participant’s stationary balance is assessed through two main tests: Tandem, Semi Tandem and Full Tandem standing timed tests, and the Wii Balance Board pressure assessmentThe timed balance test is an adaptation of the 4 stage balance test outlined by the American Centre for Disease control and Prevention ADDIN EN.CITE <EndNote><Cite><Author>CDC</Author><Year>2015</Year><RecNum>11</RecNum><DisplayText>(162)</DisplayText><record><rec-number>11</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453583">11</key></foreign-keys><ref-type name="Electronic Article">43</ref-type><contributors><authors><author>CDC</author></authors><secondary-authors><author>Stopping Eldery Accidents, Deaths and Injuries</author></secondary-authors></contributors><titles><title>The 4-Stage Balance Test</title></titles><dates><year>2015</year><pub-dates><date>13/04/2015</date></pub-dates></dates><publisher>CDC</publisher><urls><related-urls><url>;(162). Participants perform each of the tests for a maximum of ten seconds and receive a numerical score correlating to their static balance proficiency. The progression throughout the test is shown below.Figure 3.1 – Foot placement for the progressive static balance tests ADDIN EN.CITE <EndNote><Cite><Author>CDC</Author><Year>2015</Year><RecNum>11</RecNum><DisplayText>(162)</DisplayText><record><rec-number>11</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453583">11</key></foreign-keys><ref-type name="Electronic Article">43</ref-type><contributors><authors><author>CDC</author></authors><secondary-authors><author>Stopping Eldery Accidents, Deaths and Injuries</author></secondary-authors></contributors><titles><title>The 4-Stage Balance Test</title></titles><dates><year>2015</year><pub-dates><date>13/04/2015</date></pub-dates></dates><publisher>CDC</publisher><urls><related-urls><url>;(162)In the WBB test participants stand with their feet side by side, in a stationary position. Participants stand for a period of 30 seconds, aiming to remain as stationary as possible, whilst specifically designed computer software tracks minute changes in their balance of the period. The WBB has been demonstrated as a viable replacement for a laboratory grade force platform ADDIN EN.CITE <EndNote><Cite><Author>Clark</Author><Year>2010</Year><RecNum>16</RecNum><DisplayText>(163)</DisplayText><record><rec-number>16</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453596">16</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Clark, Ross A</author><author>Bryant, Adam L</author><author>Pua, Yonghao</author><author>McCrory, Paul</author><author>Bennell, Kim</author><author>Hunt, Michael</author></authors></contributors><titles><title>Validity and reliability of the Nintendo Wii Balance Board for assessment of standing balance</title><secondary-title>Gait & posture</secondary-title></titles><periodical><full-title>Gait & posture</full-title></periodical><pages>307-310</pages><volume>31</volume><number>3</number><dates><year>2010</year></dates><isbn>0966-6362</isbn><urls><related-urls><url>;(163), and was consequently selected for inclusion within the study.3.3 Sarcopenia and Obesity DefinitionsSarcopenia was initially defined by the use of the EWGSOP criteria for sarcopenia diagnosis ADDIN EN.CITE <EndNote><Cite><Author>Cruz-Jentoft</Author><Year>2010</Year><RecNum>18</RecNum><DisplayText>(51)</DisplayText><record><rec-number>18</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453600">18</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cruz-Jentoft, AJ</author><author>Baeyens, JP</author><author>Bauer, JM</author><author>Boirie, Y</author><author>Cederholm, T</author><author>Landi, F</author><author>Martin, FC</author><author>Michel, JP</author><author>Rolland, Y</author><author>Schneider, SM</author><author>Topinkova, E</author><author>Vandewoude, M</author><author>Zamboni, M</author></authors></contributors><titles><title>Sarcopenia: European consensus on definition and diagnosis</title><secondary-title>Age Aging</secondary-title></titles><periodical><full-title>Age Aging</full-title></periodical><pages>412-423</pages><volume>39</volume><number>4</number><edition>April 13th 2010</edition><dates><year>2010</year></dates><urls></urls></record></Cite></EndNote>(51), with comparisons made to other recognised definitions such as that of DaSilva et al. ADDIN EN.CITE <EndNote><Cite><Author>Da Silva Alexandre</Author><Year>2014</Year><RecNum>146</RecNum><DisplayText>(52)</DisplayText><record><rec-number>146</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445082258">146</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Da Silva Alexandre, Tiago</author><author>Duarte, YA De Oliveira</author><author>Santos, JL Ferreira</author><author>Wong, Rebeca</author><author>Lebr?o, Maria Lúcia</author></authors></contributors><titles><title>Sarcopenia according to the European Working Group on Sarcopenia in Older People (EWGSOP) versus dynapenia as a risk factor for mortality in the elderly</title><secondary-title>The journal of nutrition, health & aging</secondary-title></titles><periodical><full-title>The journal of nutrition, health & aging</full-title></periodical><pages>751-756</pages><volume>18</volume><number>8</number><dates><year>2014</year></dates><isbn>1279-7707</isbn><urls></urls></record></Cite></EndNote>(52), Batsis et al. ADDIN EN.CITE <EndNote><Cite><Author>Batsis</Author><Year>2015</Year><RecNum>186</RecNum><DisplayText>(164)</DisplayText><record><rec-number>186</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445744631">186</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Batsis, John A</author><author>Mackenzie, Todd A</author><author>Lopez-Jimenez, Francisco</author><author>Bartels, Stephen J</author></authors></contributors><titles><title>Sarcopenia, Sarcopenic Obesity and Functional Impairments in Older Adults: NHANES 1999-2004</title><secondary-title>Nutrition Research</secondary-title></titles><periodical><full-title>Nutrition Research</full-title></periodical><dates><year>2015</year></dates><isbn>0271-5317</isbn><urls></urls></record></Cite></EndNote>(164) Fielding et al. ADDIN EN.CITE <EndNote><Cite><Author>Fielding</Author><Year>2011</Year><RecNum>219</RecNum><DisplayText>(165)</DisplayText><record><rec-number>219</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445861406">219</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Fielding, Roger A</author><author>Vellas, Bruno</author><author>Evans, William J</author><author>Bhasin, Shalender</author><author>Morley, John E</author><author>Newman, Anne B</author><author>van Kan, Gabor Abellan</author><author>Andrieu, Sandrine</author><author>Bauer, Juergen</author><author>Breuille, Denis</author></authors></contributors><titles><title>Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia</title><secondary-title>Journal of the American Medical Directors Association</secondary-title></titles><periodical><full-title>Journal of the American Medical Directors Association</full-title></periodical><pages>249-256</pages><volume>12</volume><number>4</number><dates><year>2011</year></dates><isbn>1525-8610</isbn><urls></urls></record></Cite></EndNote>(165) or Chumlea et al. ADDIN EN.CITE <EndNote><Cite><Author>Chumlea</Author><Year>2011</Year><RecNum>220</RecNum><DisplayText>(166)</DisplayText><record><rec-number>220</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445861414">220</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Chumlea, WM C</author><author>Cesari, M</author><author>Evans, WJ</author><author>Ferrucci, L</author><author>Fielding, RA</author><author>Pahor, M</author><author>Studenski, S</author><author>Vellas, B</author></authors></contributors><titles><title>International working group on Sarcopenia</title><secondary-title>The journal of nutrition, health & aging</secondary-title></titles><periodical><full-title>The journal of nutrition, health & aging</full-title></periodical><pages>450-455</pages><volume>15</volume><number>6</number><dates><year>2011</year></dates><isbn>1279-7707</isbn><urls></urls></record></Cite></EndNote>(166). In current literature the EWGSOP definition appears as the primary definition of sarcopenia, and is perhaps the most widely accepted. A table summarizing the different definitions and consequential participant allocation numbers is found in Table 1. Table 2 provides a summary of common definitions used in order to classify obesity. Dufour et al. (2012) and the total body fat percentage cut off’s outlined in his work were utilised within our study in favour of the more regularly used, BMI. BMI outlined by the WHO have fallen out of favour in much current research, due to a lack of onus placed on adipose mass. BMI has also been shown as unsuitable for older participants due to differences in body composition ADDIN EN.CITE <EndNote><Cite><Author>Evans</Author><Year>2006</Year><RecNum>158</RecNum><DisplayText>(82)</DisplayText><record><rec-number>158</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445085147">158</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Evans, EM</author><author>Rowe, DA</author><author>Racette, SB</author><author>Ross, KM</author><author>McAuley, E</author></authors></contributors><titles><title>Is the current BMI obesity classification appropriate for black and white postmenopausal women?</title><secondary-title>International Journal of Obesity</secondary-title></titles><periodical><full-title>International journal of obesity</full-title></periodical><pages>837-843</pages><volume>30</volume><number>5</number><dates><year>2006</year></dates><isbn>0307-0565</isbn><urls><related-urls><url>;(82). 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ADDIN EN.CITE.DATA (51, 52, 164-166)Sarcopenia DefinitionCategoryDefinitionFrequencyPercentageGait Speed Cut OffSarcopenic<0.8m/s3249.20%Non-Sarcopenic≥0.8m/s3350.8Hand Grip Strength Cut OffSarcopenic<20kg Female<30kg Male1320%Non-Sarcopenic≥ 20kg Female≥ 30kg Male5280%IWGSSarcopenicGait Speed <1m/s;ALM <7.22kg/m2 Male; ALM<5.66kg/m2 Female00%Non-SarcopeniaGait Speed <1m/s 65100%EWGSOPSarcopenicGait Speed <0.8m/s;Hand Grip Strength <20kg Female, <30kg Male; ALM <7.26kg/m2 Male; ALM <5.50kg/m2 Female00%Non-SarcopenicALM > 7.26kg/m2 Male, ALM >5.51kg/m2 Female65100%EWGSOP (Da Silva)SarcopenicALM <8.90kg/m2 Male, ALM <6.36kg/m2 Female913.80%Non-SarcopenicALM >8.90kg/m2 Male, ALM >6.36kg/m2 Female5686.20%Batsis et al. (Total ALM)SarcopenicALM <19.75kg Male, ALM < 15.02kg Female23.10%Non-SarcopenicALM > 19.75kg Male, ALM > 15.02kg Female6396.90%Table 2. Obesity definitions and incidence according to WHO BMI, Dufour et al. Total Body Fat Percentage (TBFP), International Diabetes Federation (IDF) Waist Circumference PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5XSE8gRXhwZXJ0IENvbnN1bHRhdGlvbjwvQXV0aG9yPjxZ
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ADDIN EN.CITE.DATA (74, 81, 134)SourceCategoryDefinitionFrequencyPercentageWHOObeseBMI >30kg/m23756.90%Overweight BMI 25-29.9kg/m22843.10%NormalBMI 20-24.9kgm/200.0%Dufour et al.ObeseTBFP >30% Male4163.10%TBFP >40% FemaleOverweight ?TBFP <30% Male2436.90%TBFP <40% Female??IDFObeseWaist Circumference >90cm Males5889%Waist Circumference >80cm FemalesOverweight ?Waist Circumference <90cm Males7?11%Waist Circumference >80cm Females?Contribution to the studyI screened >40 potential participants between April and August 2015. 27 participants were subsequently included in the study, with 11 other participants who were interested, yet did not meet the specific inclusion criteria, included in an additional concomitant study. That study is however outside the scope of this thesis. Once participants had been screened for eligibility, and an appointment made at Sunshine Hospital’s WCHRE, I was charged with the responsibility of contacting local general practitioners and obtaining approval for the research project. I additional organised all paperwork, conducted pre-visit and familiarisation phone calls with the participants, and assisted with the generation of anthropometric measurements, and strength measures on the day of testing. I was also responsible for data entry, and generation of participant reports, to be distributed to both general practitioners, and participants themselves. These tasks were shared with the aid of a Melbourne University Honours student, and a research assistant.Participant GroupingParticipants were to be initially assigned to one of 3 categories (pre-sarcopenic, sarcopenic, severe sarcopenic), based on the European Working Group on Sarcopenia in Older People (EWGSOP) (see Methods) definition of sarcopenia PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DcnV6LUplbnRvZnQ8L0F1dGhvcj48WWVhcj4yMDEwPC9Z
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ADDIN EN.CITE.DATA (51, 52). Participants were then further classified into overweight or obese categories based on cut points of total body fat percentage, as outlined by Dufour et al. (2012) (Obese, Non-Obese) ADDIN EN.CITE <EndNote><Cite><Author>Dufour</Author><Year>2012</Year><RecNum>185</RecNum><DisplayText>(81)</DisplayText><record><rec-number>185</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445097034">185</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Dufour, Alyssa B</author><author>Hannan, Marian T</author><author>Murabito, Joanne M</author><author>Kiel, Douglas P</author><author>McLean, Robert R</author></authors></contributors><titles><title>Sarcopenia definitions considering body size and fat mass are associated with mobility limitations: the Framingham Study</title><secondary-title>The Journals of Gerontology Series A: Biological Sciences and Medical Sciences</secondary-title></titles><periodical><full-title>The Journals of Gerontology Series A: Biological Sciences and Medical Sciences</full-title></periodical><pages>gls109</pages><dates><year>2012</year></dates><isbn>1079-5006</isbn><urls></urls></record></Cite></EndNote>(81). However, it became apparent that the EWGSOP criterion resulted in no individuals classed within the severe sarcopenic, or sarcopenic categories due to lower ALM cut offs than those of any participants. The cut points used by the EWGSOP were then adapted to those employed by Da Silva et al. ADDIN EN.CITE <EndNote><Cite><Author>Da Silva Alexandre</Author><Year>2014</Year><RecNum>146</RecNum><DisplayText>(52)</DisplayText><record><rec-number>146</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445082258">146</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Da Silva Alexandre, Tiago</author><author>Duarte, YA De Oliveira</author><author>Santos, JL Ferreira</author><author>Wong, Rebeca</author><author>Lebr?o, Maria Lúcia</author></authors></contributors><titles><title>Sarcopenia according to the European Working Group on Sarcopenia in Older People (EWGSOP) versus dynapenia as a risk factor for mortality in the elderly</title><secondary-title>The journal of nutrition, health & aging</secondary-title></titles><periodical><full-title>The journal of nutrition, health & aging</full-title></periodical><pages>751-756</pages><volume>18</volume><number>8</number><dates><year>2014</year></dates><isbn>1279-7707</isbn><urls></urls></record></Cite></EndNote>(52) The combination of those two categorisations gave the following 6 groups, with the number of participants (n) in each group:Pre-Sarcopenic Non-Obese n=18Sarcopenic Non-Obese n=19Severe Sarcopenic Non-Obese n=4Pre-Sarcopenic Obese n=7Sarcopenic Obese n=15Severe Sarcopenic Obese n=2Given the small number of participants with severe sarcopenia these groups were amalgamated with the sarcopenia groups. Thus, the expected final groupings and number of participants subsequent analysis were:Pre-Sarcopenic Non-Obese n=18Sarcopenic Non-Obese n=23Pre-Sarcopenic Obese n=7Sarcopenic Obese n=17These groups however, were deemed inappropriate, with mistakes in participant allocation resulting in some non-sarcopenic participants falling into sarcopenic categorisation due to low gait speed and low grip strength, rather than due to their lean mass measures (see Methods for further details). As such this categorisation was abandoned. Employing an adaption on the EWGSOP definition of sarcopenia, participants in the lowest 20% of ALM/height2 measures were classified as sarcopenic. The total body fat percentage cut offs as employed earlier were retained. Participants were subsequently grouped as follows, with (n) depicting the numbers within each groups.Non-Sarcopenic Non-Obese (n=20)Non-Sarcopenic Obese (n=33)Sarcopenic Non-Obese (n=4)Sarcopenic Obese (n=8)Total Non-obese n = 24Total Non-Sarcopenic n = 53Total Obese n = 41Total Sarcopenic n = 12Total n = 65Statistical AnalysisDifferences between the four groups were assessed using a Two-Way MANOVA with sarcopenia and obesity as the two factors. Pearson product-moment correlation coefficient (r) was used to determine any relationships between indices of muscle and strength, DXA derived anthropometry and BMD, and pQCT bone parameters across all participants. Further correlation was performed in a total body weight adjusted model, and an absolute ALM adjusted model. All statistical analysis was performed using SPSS software version 22. An alpha value of p < 0.05 was denoted as significant.Results6.1 Comparison between 2013/14 and 2015 cohortsThe full Table 4 (see appendix 1) presents descriptive statistics from individuals recruited in 2015 (n=27, 33% male), an abridged version (Table 3) presents a summary of these statistics. Males were significantly taller and heavier than females however; males did have significantly lower total body fat. Males had significantly greater hand grip strength (HGS) and leg extension strength (LES) than females. There was no difference between the sexes for average stair climb speed, or mean gait speed. Males had significantly higher lean mass measures at all sites (left arm, right arm, left leg, right leg), including total ALM. Males had significantly higher muscle CSA at both the proximal radius and proximal tibia. Men had greater DXA derived BMD measures at all sites. Whole-body T-scores were also significantly higher in males than females. pQCT measures of proximal radius cortical bone area and thickness were also significantly greater in males, along with proximal tibia cortical area and thickness.Table 3. Summary of descriptive statistics from Table 4FactorSexP ValueMale (N=9)Female (N=18)Sig.General?mean ± SDmean ± SD?Age (y)64 ± 1063 ± 90.77Height (cm)173 ± 4160 ± 70.00Weight (kg)94.7 ± 12.978.8 ± 17.60.02Physical Performance????Hand Grip Strength (kg)41.0 ± 6.224.8 ± 7.60.00Leg Extension Strength (kg)28.1 ± 6.521.7 ± 5.90.02Average Stair Climb (s)5.0 ± 1.35.4 ± 1.70.61Gait Speed (m/s)0.8 ± 0.10.8 ± 0.20.54Anthropometry????Total body fat (kg)31.6 ± 5.040.5 ± 6.70.00Bone Density (T-score)0.9 ± 1.8-1.6 ± 1.60.02Subtotal BMD (mg/cm3)1.1 ± 0.20.9 ± 0.10.00Left Arm BMD (mg/cm3)1.0 ± 0.10.7 ± 0.10.00Right Arm BMD (mg/cm3)1.0 ± 0.20.7 ± 0.10.00Left Leg BMD (mg/cm3)1.3 ± 0.41.0 ± 0.20.03Right Leg BMD (mg/cm3)1.3 ± 0.31.0 ± 0.30.04Proximal TibiaMuscle CSA (mm2)8438.0 ± 1149.56808.2 ± 1403.30.01Cortical Area (mm2)361.3 ± 55.4256.4 ± 47.90.00Cortical Thickness (mm)4.4 ± 0.83.4 ± 0.70.00Proximal RadiusMuscle CSA (mm2)4375.8 ± 727.22803.9 ± 554.30.00IMAT (mm2)643.7 ± 255.9364.4 ± 146.10.01Cortical Area (mm2)98.7 ± 14.759.3 ± 12.30.00Cortical Thickness (mm)2.1 ± 0.31.4 ± 0.30.00Mass MeasuresAppendicular Lean Mass (kg)27.9 ± 3.319.6 ± 3.70.00Full descriptive statistics of the whole cohort (n=65) in Table 5 (see appendix 2) show several differences to those noted in Table 3 and Table 4. Sixty five participants were tested during this portion of the analysis rather than the 67 as previously stated, as two individuals did not complete the full battery of tests, and were subsequently excluded from the entire analysis. The significant difference in whole-body T-scores was lost, along with the significant difference in LES between sexes. All other significance between sexes was retained from Table 3.Participants in the 2013/14 cohort were compared to individuals within the 2015 cohort through the use of an independent samples t-test, as reported in the full Table 6 (see appendix 3). There were significant differences between the cohorts in vitamin D level (p = 0.03), and blood glucose levels (p = 0.03). LES was the only physical performance parameter that was significantly different between cohorts (p < 0.01). Proximal radius cortical thickness was significantly different (P = 0.01), whilst no other differences between cohorts were observed within any DXA or pQCT derived bone density, lean mass or adipose mass measures. There were no significant differences between any self-administered questionnaire responses. Given the relatively few differences between cohorts, the 2013/2014 participants were amalgamated with 2015 for the ensuing analysis included below.6.2 Appendicular Lean Mass and ObesityALM was significantly different between sarcopenic categories, as should be expected given it plays a significant role in sarcopenic diagnosis. There was no significant interaction effect between sarcopenia and obesityFigure 6.1. Difference in Appendicular Lean Mass between groups, with a significant difference between sarcopenic obese, and sarcopenic non-obese participants.Non-sarcopenic participants had the greatest total ALM, whilst there was no significant difference between obese and non-obese. ALM was positively correlated with 1; BMD measures at all DXA sites, 2) proximal radius and tibia cortical bone area and thickness (Table 3.1), 3) HGS (r = 0.677, p <0.01), and 4) muscle CSA at both sites(r = 0.807, p<0.01 & r = 0.807, p < 0.01) amongst others(Table 8)Table 3.1. Correlations of Appendicular Lean Mass with BMD measures and specific bone geometryAppendicular Lean Mass (kg)Anthropometry?N ≥ 63?Bone Density (T-score)r0.416p< 0.01Subtotal BMD (g/cm2)r0.613p< 0.01Left Arm BMD (g/cm2)r0.673p< 0.01Right Arm BMD (g/cm2)r0.576p< 0.01Left Leg BMD (g/cm2)r0.457p< 0.01Right Leg BMD (g/cm2)r0.403p< 0.01Proximal Tibia??Cortical Area (mm2)r0.761p< 0.01Cortical Thickness (mm)r0.542p< 0.01Proximal Radius??Cortical Area (mm2)r0.732p< 0.01Cortical Thickness (mm)r0.436p< 0.01ALM levels demonstrated a negative relationship with total body fat (r = -0.495, p < 0.01) (Table 9). ALM retained all these significant relationships in a total body weight adjusted model (Table 11; see appendix 8). A full table summarising ALM can be seen in appendix 56.3 Gait SpeedFigure 6.2 depicts the differences in gait speed between participants. There was no significant difference between obesity groups, nor sarcopenic groups, with no interaction effect noted. Figure 6.2. Gait Speed differences between sarcopenic and obese groups26530302994660r = -0.527p < 0.01020000r = -0.527p < 0.01Gait speed did not show a relationship with BMD parameters from DXA or pQCT, however a positive significant relationship was seen at the proximal tibia with cortical thickness, which remained whilst adjusted for body weight (r=0.269, p=0.04) (Table 10). As expected, stair climb speed showed a strong negative relationship with gait speed (Figure 6.3 & Table 9; see appendix 6). No other significant relationship was observed for mean gait speedFigure 6.3. The association between gait speed and average stair climb time in older adults6.4 Hand Grip StrengthAs shown in Figure 6.4, there were no significant differences in hand grip strength (HGS) between obesity category, and sarcopenic groups.Figure 6.4 – Hand Grip Strength between sarcopenic and obese groupsObese participants posted lower HGS results than non-obese participants, irrespective of their sarcopenia status; the difference however, was non-significant. HGS was positively associated with BMD measures at all DXA (Table 3.2) sites including whole-body DXA T-score as shown in Figure 6.5. HGS demonstrated a much stronger positive relationship with proximal radius cortical bone area and thickness, which remained following adjustment for total body weight (r =0.586, p <0.01 & r = 0.375, p <0.01) (Table 10; see appendix 7).Table 3.2. The relationship between hand grip strength and bone density parameters in older adultsHand Grip Strength (kg)N≥63?????Total body fat (kg)r-0.525p< 0.01Subtotal BMD (g/cm2)r0.469p< 0.01Left Arm BMD (g/cm2)r0.603p< 0.01Right Arm BMD (g/cm2)r0.485p< 0.01Left Leg BMD (g/cm2)r0.341p0.005Right Leg BMD (g/cm2)r0.306p0.0135021126427512r = 0.235p = 0.05020000r = 0.235p = 0.05Figure 6.5. Hand Grip strength versus whole-body DXA T-score valuesThe significant relationship with all BMD measures was lost however within the right and left leg once adjusted for total body weight (Table 10). HGS showed a strong positive relationship with LES which remained after adjustment for total body weight (r = 0.458, p <0.01). There was no significant relationship with any other strength measures (Table 9; see appendices). HGS was positively correlated with both proximal radius muscle CSA (r = 0.758, p <0.01) and ALM (r = 0.677, p < 0.01). HGS also showed an inverse relationship to all DXA derived adipose measure as seen below in Table 3.3.Table 3.3 The relationship between hand grip strength and adipose mass measures in older adultsHand Grip Strength (kg)N≥63Mass MeasuresAppendicular Lean Mass (kg)r0.677p< 0.01Arm Fat (kg)r-0.333p< 0.01Arms Lean Mass (kg)r0.734p< 0.01Leg Fat (kg)r-0.302p0.015Legs Lean Mass (kg)r0.626p<0.016.5 Leg Extension StrengthLeg extension strength (LES), showed no significant differences between obese groups. There was however an interaction effect and further post-hoc analysis demonstrated that sarcopenic obese participants had significantly greater LES than sarcopenic non-obese participants.Figure 6.6. Leg Extension Strength between groups, a significant difference was observed between the sarcopenic obese and sarcopenic non-obese participants.LES was positively related to proximal tibia cortical bone area and thickness (r = 0.248, p = 0.05 & r = 0.264, p = 0.03). There was no relationship with any other bone measures (Tables 8 & 10). LES did not show a correlation with muscle mass measures from DXA or pQCT, there was however a positive correlation between LES and average stair climb (r = -0.322, p <0.01).1504950243840R = 0.347p = 0.004020000R = 0.347p = 0.004 Figure 6.7. Hand grip strength versus Leg extension strength correlationHGS and LES were also positively associated (r = 0.347, p < 0.01) as can be seen in Figure 6.7(Table 9). All significant relationships remained following adjustment for total body weight (Table 11).6.6 Whole-Body Bone Density and AdiposityFigure 6.8 depicts the differences in whole-body DXA T-score of sarcopenic and obese groups. There was no significant difference in whole-body DXA T-score between obese and non-obese participants, nor between sarcopenic and non-sarcopenic participants. There was also no significant interaction of sarcopenia and obesity within T-score results (Table 7; see appendix 4).Figure 6.8. DXA T-score results between sarcopenic and obesity groupsBMD at all sites (Table 3.3), and whole-body T-score were positively associated along with height (r = 0.304, p = 0.01) and weight (r = 0.459, p< 0.01) (Table 3.3;Table 8). Proximal tibia and radius cortical bone area and thickness were both significantly correlated with T-score values respectively shown in Table 3.3. Table 3.3 Whole-body DXA T-score associations with other bone health parameters in older adultsBone Density (T-score)?N≥63??Anthropometry??Subtotal BMD (g/cm2)r0.903p< 0.01Left Arm BMD (g/cm2)r0.551p< 0.01Right Arm BMD (g/cm2)r0.534p< 0.01Left Leg BMD (g/cm2)r0.826p< 0.01Right Leg BMD (g/cm2)r0.839p< 0.01Proximal Tibia???Cortical Area (mm2)r0.541p< 0.01Cortical Thickness (mm)r0.521p< 0.01Proximal Radius???Cortical Area (mm2)r0.447p< 0.01Cortical Thickness (mm)r0.355p< 0.01Figure 6.9. Appendicular Lean Mass versus whole-body DXA T-scoreWhole-body T-score BMD were significantly positively associated with absolute ALM, as displayed above in Figure 6.9 (Table 8). Whole-body DXA T-score values were also strongly positively correlated with muscle CSA at both proximal tibia(r = 0.349, p <0.01 ) and proximal radius (r = 0.327, p < 0.01).There was no significant relationship with any physical performance measures (Table 9). DiscussionIn this study of adults over the age of 50, obesity status did not have a significant impact upon physical performance, or bone health measures. Sarcopenia, or lower ALM, also did not appear to show a significant impact upon physical strength and function or bone health in a majority of instances. Bone health measures were however, well correlated with measures of lean muscle tissue, and increasing strength measures, namely HGS, Gait Speed, and LES.In a total body weight adjusted model HGS was positively correlated with DXA BMD measures at all sites, along with specific pQCT measures, such as proximal radius cortical bone thickness and area. HGS has been shown as an independent predictor of both whole-body BMD and also of radial bone loading in multiple studies PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYXJ0aWVuPC9BdXRob3I+PFllYXI+MjAxNTwvWWVhcj48
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ADDIN EN.CITE.DATA (22, 168, 169). HGS may be related to these bone parameters via the mechanical forces exerted by muscles on their bone attachments, as described in mechanostat theory ADDIN EN.CITE <EndNote><Cite><Author>Frost</Author><Year>2000</Year><RecNum>204</RecNum><DisplayText>(170, 171)</DisplayText><record><rec-number>204</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445749085">204</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Frost, Harold M</author></authors></contributors><titles><title>The Utah paradigm of skeletal physiology: an overview of its insights for bone, cartilage and collagenous tissue organs</title><secondary-title>Journal of bone and mineral metabolism</secondary-title></titles><periodical><full-title>Journal of bone and mineral metabolism</full-title></periodical><pages>305-316</pages><volume>18</volume><number>6</number><dates><year>2000</year></dates><isbn>0914-8779</isbn><urls></urls></record></Cite><Cite><Author>Frost</Author><Year>1960</Year><RecNum>205</RecNum><record><rec-number>205</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445749212">205</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Frost, HM</author></authors></contributors><titles><title>The Utah Paradigm of Skeletal Physiology Vol. 1</title><secondary-title>ISMNI [1]</secondary-title></titles><periodical><full-title>ISMNI [1]</full-title></periodical><dates><year>1960</year></dates><urls></urls></record></Cite></EndNote>(170, 171). Specifically muscle forces applied to bones may produce subsequent deformations within the cortical layer of the proximal osseous tissue. Consequential bone-remodelling in response to this stress would then result in a greater cortical thickness. Therefore the greater the force exerted by the muscle upon the bone, the greater the subsequent deformations and ensuing modelling. Given bone remodelling and adaptations are known to be a lifelong process PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Eb2RkczwvQXV0aG9yPjxZZWFyPjE5OTU8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (172, 173) it should be un-surprising that our older participants see such adaption, and as such further correlation between their HGS and radial cortical thickness should be expected. Interestingly the reverse phenomenon has been observed in long serving astronauts who’s muscles no longer subject to gravitation effect, cannot exert sufficient strain on their bones ADDIN EN.CITE <EndNote><Cite><Author>Grimston</Author><Year>1993</Year><RecNum>199</RecNum><DisplayText>(174, 175)</DisplayText><record><rec-number>199</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445745369">199</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Grimston, SUSAN K</author><author>Willows, NOREEN D</author><author>Hanley, DAVID A</author></authors></contributors><titles><title>Mechanical loading regime and its relationship to bone mineral density in children</title><secondary-title>Medicine and science in sports and exercise</secondary-title></titles><periodical><full-title>Medicine and science in sports and exercise</full-title></periodical><pages>1203-1210</pages><volume>25</volume><number>11</number><dates><year>1993</year></dates><isbn>0195-9131</isbn><urls></urls></record></Cite><Cite><Author>Holick</Author><Year>1998</Year><RecNum>206</RecNum><record><rec-number>206</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445749478">206</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Holick, Michael F</author></authors></contributors><titles><title>Perspective on the impact of weightlessness on calcium and bone metabolism</title><secondary-title>Bone</secondary-title></titles><periodical><full-title>Bone</full-title></periodical><pages>105S-111S</pages><volume>22</volume><number>5</number><dates><year>1998</year></dates><isbn>8756-3282</isbn><urls></urls></record></Cite></EndNote>(174, 175). Given the proximity of muscles vital to force development within HGS, it should be expected that the mechanostat effect propagates most significantly in proximal bone localisations, such as radial cortical thickness, or radial cortical bone density. Cortical bone thickness has been shown as an important indicator of bone strength at multiple sites, and whilst cortical porosity and trabecular structure are also important, cortical thickness may determine a large aspect of overall bone strength ADDIN EN.CITE <EndNote><Cite><Author>Kaji</Author><Year>2005</Year><RecNum>193</RecNum><DisplayText>(176)</DisplayText><record><rec-number>193</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445745152">193</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kaji, Hiroshi</author><author>Kosaka, Rieko</author><author>YAMAUCHI, Mika</author><author>KUNO, Kaoru</author><author>CHIHARA, Kazuo</author><author>SUGIMOTO, Toshitsugu</author></authors></contributors><titles><title>Effects of age, grip strength and smoking on forearm volumetric bone mineral density and bone geometry by peripheral quantitative computed tomography: comparisons between female and male</title><secondary-title>Endocrine journal</secondary-title></titles><periodical><full-title>Endocrine journal</full-title></periodical><pages>659-666</pages><volume>52</volume><number>6</number><dates><year>2005</year></dates><isbn>0918-8959</isbn><urls><related-urls><url>;(176) and health. Cortical thickness was shown to explain up to 41% of bone failure, or fracture, at the femoral neck in an ex-vivo study ADDIN EN.CITE <EndNote><Cite><Author>Bousson</Author><Year>2006</Year><RecNum>188</RecNum><DisplayText>(177)</DisplayText><record><rec-number>188</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445744885">188</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Bousson, Vet al</author><author>Le Le Bras, A</author><author>Roqueplan, F</author><author>Kang, Y</author><author>Mitton, D</author><author>Kolta, S</author><author>Bergot, C</author><author>Skalli, W</author><author>Vicaut, E</author><author>Kalender, W</author></authors></contributors><titles><title>Volumetric quantitative computed tomography of the proximal femur: relationships linking geometric and densitometric variables to bone strength. Role for compact bone</title><secondary-title>Osteoporosis international</secondary-title></titles><periodical><full-title>Osteoporosis international</full-title></periodical><pages>855-864</pages><volume>17</volume><number>6</number><dates><year>2006</year></dates><isbn>0937-941X</isbn><urls><related-urls><url>;(177), and with much greater forces exerted through the radius should an older individual fall, cortical thickness demonstrates its important role ADDIN EN.CITE <EndNote><Cite><Author>Szulc</Author><Year>2013</Year><RecNum>195</RecNum><DisplayText>(169)</DisplayText><record><rec-number>195</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445745224">195</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Szulc, Pawel</author><author>Blaizot, Stéphanie</author><author>Boutroy, Stephanie</author><author>Vilayphiou, Nicolas</author><author>Boonen, Steven</author><author>Chapurlat, Roland</author></authors></contributors><titles><title>Impaired bone microarchitecture at the distal radius in older men with low muscle mass and grip strength: the STRAMBO study</title><secondary-title>Journal of Bone and Mineral Research</secondary-title></titles><periodical><full-title>Journal of Bone and Mineral Research</full-title></periodical><pages>169-178</pages><volume>28</volume><number>1</number><dates><year>2013</year></dates><isbn>1523-4681</isbn><urls><related-urls><url>;(169). Research has suggested that should an individual fall, radial bone density and geometry may be a more significant determinant of subsequent fracture irrespective of physical health and function levels ADDIN EN.CITE <EndNote><Cite><Author>Kelsey</Author><Year>1992</Year><RecNum>197</RecNum><DisplayText>(178)</DisplayText><record><rec-number>197</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445745298">197</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kelsey, Jennifer L</author><author>Browner, Warren S</author><author>Seeley, Dana G</author><author>Nevitt, Michael C</author><author>Cummings, Steven R</author></authors></contributors><titles><title>Risk factors for fractures of the distal forearm and proximal humerus</title><secondary-title>American Journal of Epidemiology</secondary-title></titles><periodical><full-title>American journal of epidemiology</full-title></periodical><pages>477-489</pages><volume>135</volume><number>5</number><dates><year>1992</year></dates><isbn>0002-9262</isbn><urls><related-urls><url>;(178). Our other important measure of physical strength relied upon throughout the analysis was the LES; which unlike HGS demonstrated very few associations with bone density measures. LES has been shown in past research as a reliable indicator of total body strength, physical function PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5WaXNzZXI8L0F1dGhvcj48WWVhcj4yMDAyPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA (16, 32) and bone health at various sites, whilst in our study only proximal tibia cortical thickness and area displayed a significant relationship. The LES is however a primary test of quadriceps extension strength, with possible mechanostat effect occurring bones in a closer proximity to the muscles such as; pelvic or femoral bones, rather than lower leg bones such as the tibia. Such an effect would explain the weaker correlation between LES and bone health parameters, compared to HGS, whilst also providing a substantiated point of interest for further testing upon femoral bone density.The LES saw enormous amounts of variance within the LES test, particularly between the 2013/14 and 2015 cohort, and this may be a contributing factor to the lack of correlations found with the measure. The LES administered within our protocol was prone to significant amounts of operator variance from week to week, as the test was difficult to administer in a reliable manner. Furthermore the use of a hand held dynamometer in the test also complicated the testing, with the angle at which the lower leg made contact with the device, influencing the recorded force output, in spite of the perceived effort from the participant. Along with the different testers for the LES in past years, test protocol or administration may have varied greatly. These potential flaws within the test may help to explain why the LES assessment was not included into the EWGSOP criteria for sarcopenia, and perhaps provide further justification for the more easily testable and reliable gait speed test and HGS.In spite of these shortcomings, our data further supports evidence, that maintenance of sufficient strength levels throughout aging may be protective in fractures ADDIN EN.CITE <EndNote><Cite><Author>Metter</Author><Year>2002</Year><RecNum>46</RecNum><DisplayText>(13)</DisplayText><record><rec-number>46</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453642">46</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Metter, E Jeffrey</author><author>Talbot, Laura A</author><author>Schrager, Matthew</author><author>Conwit, Robin</author></authors></contributors><titles><title>Skeletal muscle strength as a predictor of all-cause mortality in healthy men</title><secondary-title>The Journals of Gerontology Series A: Biological Sciences and Medical Sciences</secondary-title></titles><periodical><full-title>The Journals of Gerontology Series A: Biological Sciences and Medical Sciences</full-title></periodical><pages>B359-B365</pages><volume>57</volume><number>10</number><dates><year>2002</year></dates><isbn>1079-5006</isbn><urls><related-urls><url>;(13) as a result of increased bone density through the whole body, and at specific bone geometry sites, notable though the significant positive correlation between HGS with cortical area and thickness. Our hypothesis that sarcopenia, or low strength and low mass, will be negatively correlated with bone health, is there by partially confirmed.Total body weight has also been shown to correlate well with increased BMD, and may influence changes as a result of increased load bearing. In this study, adiposity (total body fat percentage) and whole-body DXA T-scores were positively associated with each other, yet significance of this relationship was lost upon adjustment for ALM, there-by complicating the relationship between body weight and bone density. In the same instance, ALM was positively correlated with BMD and bone geometry whilst adjusted for total body weight.This result disproves the hypothesis that obesity will be positively correlated with bone health, whilst simultaneously confirming the hypothesis, that sarcopenia, or lower levels of both mass and strength will be negatively correlated with bone health.Although ALM has been repeatedly shown as a reliable indicator of overall bone density our research appears to be the first to show this similar relationship in an older population characterised as sarcopenic. ALM should be expected to elicit an effect upon bone density though a number of mechanisms, however, most notably as a result of increased load bearing due to increased body mass. An increase in load bearing by bones as a result of gravitational forces induced from greater lean mass has been shown to significantly impact femoral neck BMD, more so than adiposity alone ADDIN EN.CITE <EndNote><Cite><Author>Leslie</Author><Year>2014</Year><RecNum>200</RecNum><DisplayText>(179)</DisplayText><record><rec-number>200</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445745405">200</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Leslie, William D</author><author>Orwoll, Eric S</author><author>Nielson, Carrie M</author><author>Morin, Suzanne N</author><author>Majumdar, Sumit R</author><author>Johansson, Helena</author><author>Odén, Anders</author><author>McCloskey, Eugene V</author><author>Kanis, John A</author></authors></contributors><titles><title>Estimated lean mass and fat mass differentially affect femoral bone density and strength index but are not FRAX independent risk factors for fracture</title><secondary-title>Journal of Bone and Mineral Research</secondary-title></titles><periodical><full-title>Journal of Bone and Mineral Research</full-title></periodical><pages>2511-2519</pages><volume>29</volume><number>11</number><dates><year>2014</year></dates><isbn>1523-4681</isbn><urls><related-urls><url>;(179), with lean mass contributing up to 30% of variance in a whole-body measure of BMD ADDIN EN.CITE <EndNote><Cite><Author>Wang</Author><Year>2005</Year><RecNum>201</RecNum><DisplayText>(110)</DisplayText><record><rec-number>201</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445745438">201</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wang, MC</author><author>Bachrach, LK</author><author>Van Loan, M</author><author>Hudes, M</author><author>Flegal, KM</author><author>Crawford, PB</author></authors></contributors><titles><title>The relative contributions of lean tissue mass and fat mass to bone density in young women</title><secondary-title>Bone</secondary-title></titles><periodical><full-title>Bone</full-title></periodical><pages>474-481</pages><volume>37</volume><number>4</number><dates><year>2005</year></dates><isbn>8756-3282</isbn><urls><related-urls><url>(05)00211-5/abstract</url></related-urls></urls></record></Cite></EndNote>(110). Our data indicates that ALM may contribute 18% of variance in a whole-body BMD measure. It has been suggested that the lean mass impact upon bone density may be a hang-over from youth, where bones are particular responsive to remodelling ADDIN EN.CITE <EndNote><Cite><Author>Seeman</Author><Year>2002</Year><RecNum>207</RecNum><DisplayText>(180, 181)</DisplayText><record><rec-number>207</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445750049">207</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Seeman, Ego</author></authors></contributors><titles><title>Pathogenesis of bone fragility in women and men</title><secondary-title>The Lancet</secondary-title></titles><periodical><full-title>The Lancet</full-title></periodical><pages>1841-1850</pages><volume>359</volume><number>9320</number><dates><year>2002</year></dates><isbn>0140-6736</isbn><urls></urls></record></Cite><Cite><Author>Frost</Author><Year>2000</Year><RecNum>208</RecNum><record><rec-number>208</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445750057">208</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Frost, Harold M</author><author>Sch?nau, Eckhardt</author></authors></contributors><titles><title>The" muscle-bone unit" in children and adolescents: a 2000 overview</title><secondary-title>Journal of Pediatric Endocrinology and Metabolism</secondary-title></titles><periodical><full-title>Journal of Pediatric Endocrinology and Metabolism</full-title></periodical><pages>571-590</pages><volume>13</volume><number>6</number><dates><year>2000</year></dates><isbn>2191-0251</isbn><urls></urls></record></Cite></EndNote>(180, 181) as a result of changes in total body weight. The relationship between ALM, adiposity and bone density is nonetheless an extremely complicated relationship, and overall adiposity would be expected to influence bone density in a similar manner to that of ALM; increasing total body weight and load bearing. Varying research has vacillated between nominating obesity or lean mass as the most significant determinant of bone density. Some research has indicated obesity may show a greater relationship with bone density, than lean mass ADDIN EN.CITE <EndNote><Cite><Author>Reid</Author><Year>2002</Year><RecNum>203</RecNum><DisplayText>(182)</DisplayText><record><rec-number>203</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445745515">203</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Reid, Ian R</author></authors></contributors><titles><title>Relationships among body mass, its components, and bone</title><secondary-title>BoneKEy-Osteovision</secondary-title></titles><periodical><full-title>BoneKEy-Osteovision</full-title></periodical><dates><year>2002</year></dates><urls></urls></record></Cite></EndNote>(182). Findings in this area however, remain unresolved ADDIN EN.CITE <EndNote><Cite><Author>Thomas</Author><Year>2003</Year><RecNum>202</RecNum><DisplayText>(183)</DisplayText><record><rec-number>202</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445745477">202</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Thomas, Thierry</author></authors></contributors><titles><title>Leptin: a potential mediator for protective effects of fat mass on bone tissue</title><secondary-title>Joint Bone Spine</secondary-title></titles><periodical><full-title>Joint Bone Spine</full-title></periodical><pages>18-21</pages><volume>70</volume><number>1</number><dates><year>2003</year></dates><isbn>1297-319X</isbn><urls><related-urls><url>;(183) whilst our research indicates aspects of the relationship are confounding, as demonstrated by the effect of obesity between sarcopenic groups on whole-body DXA T-score values. Whilst the relative impact of adipose mass on load bearing and subsequent bone density remains tortuous, much research has indicated that older individuals, particular women may be at hormonal deficits as a result of both their age, and increased adiposity PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LYWppPC9BdXRob3I+PFllYXI+MjAwNTwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA (186-189). Other research has suggested that increased adiponectin, may in fact act to reduce bone density in obese, older adults ADDIN EN.CITE <EndNote><Cite><Author>Berner</Author><Year>2004</Year><RecNum>211</RecNum><DisplayText>(187)</DisplayText><record><rec-number>211</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1445750419">211</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Berner, Heidi S</author><author>Lyngstadaas, Staale P</author><author>Spahr, Axel</author><author>Monjo, Marta</author><author>Thommesen, Liv</author><author>Drevon, Christian A</author><author>Syversen, Unni</author><author>Reseland, Janne E</author></authors></contributors><titles><title>Adiponectin and its receptors are expressed in bone-forming cells</title><secondary-title>Bone</secondary-title></titles><periodical><full-title>Bone</full-title></periodical><pages>842-849</pages><volume>35</volume><number>4</number><dates><year>2004</year></dates><isbn>8756-3282</isbn><urls><related-urls><url>(04)00259-5/abstract</url></related-urls></urls></record></Cite></EndNote>(187). Further research in this area is needed in order to substantiate these results. Our findings regarding the impact of lean mass and obesity on bone helath suggest a link with lean mass particularly, yet the relative impact of each condition within a sarcopenic obese population remains unclear.In this study, absolute ALM, the main determinant of sarcopenic status was well correlated with HGS. As expected this relationship was even greater between HGS and upper appendage lean mass (arms), with arm lean mass explaining up to 54% of the variation within HGS values. These correlations provide an important link between muscle mass and muscle strength, a relationship which has been undermined in past research PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DbGFyazwvQXV0aG9yPjxZZWFyPjIwMDg8L1llYXI+PFJl
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ADDIN EN.CITE.DATA (41, 47, 53, 80, 190). LES demonstrated a similar relationship with ALM (table 11), yet only in the model adjusted for total body weight, adding further capacity to the link between mass and strength.As a result of this link, our main hypothesis; that muscle mass and strength will be positively correlated with each other, irrespective of obesity status, is there by confirmed.Providing a link between both mass and strength in older adults is perhaps counter intuitive too much of the current research within the field, The Health ABC study for example demonstrated that the loss of muscle strength in older adults may be up to 50% faster than concomitant loss of muscle mass ADDIN EN.CITE <EndNote><Cite><Author>Goodpaster</Author><Year>2006</Year><RecNum>29</RecNum><DisplayText>(26)</DisplayText><record><rec-number>29</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453618">29</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Goodpaster, Bret H</author><author>Park, Seok Won</author><author>Harris, Tamara B</author><author>Kritchevsky, Steven B</author><author>Nevitt, Michael</author><author>Schwartz, Ann V</author><author>Simonsick, Eleanor M</author><author>Tylavsky, Frances A</author><author>Visser, Marjolein</author><author>Newman, Anne B</author></authors></contributors><titles><title>The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study</title><secondary-title>The Journals of Gerontology Series A: Biological Sciences and Medical Sciences</secondary-title></titles><periodical><full-title>The Journals of Gerontology Series A: Biological Sciences and Medical Sciences</full-title></periodical><pages>1059-1064</pages><volume>61</volume><number>10</number><dates><year>2006</year></dates><isbn>1079-5006</isbn><urls><related-urls><url>;(26) or CSA ADDIN EN.CITE <EndNote><Cite><Author>Goodpaster</Author><Year>2001</Year><RecNum>27</RecNum><DisplayText>(191)</DisplayText><record><rec-number>27</rec-number><foreign-keys><key app="EN" db-id="0x02v2teh5rzpee0t5axrexizdfsvd99xtvr" timestamp="1430453615">27</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Goodpaster, Bret H</author><author>Carlson, Catherine L</author><author>Visser, Marjolein</author><author>Kelley, David E</author><author>Scherzinger, Ann</author><author>Harris, Tamara B</author><author>Stamm, Elizabeth</author><author>Newman, Anne B</author></authors></contributors><titles><title>Attenuation of skeletal muscle and strength in the elderly: The Health ABC Study</title><secondary-title>Journal of Applied Physiology</secondary-title></titles><periodical><full-title>Journal of Applied Physiology</full-title></periodical><pages>2157-2165</pages><volume>90</volume><number>6</number><dates><year>2001</year></dates><isbn>8750-7587</isbn><urls><related-urls><url>;(191) there by indicating the link between muscle mass and strength is not as strong as previously believed. Whilst their research was conducted upon an older group of participants than those within this study, a similar trend may be expected in our cohort later in aging. Such mixed results highlight the importance for continued, longitudinal research investigating the relationship between mass and strength, and how it may change throughout aging.Finally, a link between mass and strength as demonstrated by our research provides some form of validation for the EWGSOP criteria of sarcopenia. In spite of the fact that the use of their published criterion with our cohort did not produce one sarcopenic individual, it does provide validation of their emphasis placed upon both mass and strength. Further research is needed in order to gauge the respective importance of mass and strength respectively, and to firmly establish if there is in fact a causative link between muscle mass decline and strength decline.LimitationsThis study has a number of limitations. Given this research is part of a much larger study movement within the protocol was extremely limited. The testing protocol remained the same throughout the course of the project, with some aspects of the protocol becoming difficult to navigate. The initial cross-sectional design of the study was a primary limitation; as such inferences on causality were limited within the study. Furthermore, a cross sectional study doesn’t allow for quantification of loss of muscle mass, muscle strength, or bone health over time. Our research as such developed a single minded focus on lower levels of each factor. Whilst we were not able to provide quantified levels of muscle mass and strength loss, as per the traditional definition of sarcopenia, it is of the utmost importance that we understand the complex nature of the condition and its relationship with other aspects of our health; the cross-sectional nature has allowed for this.The lack of consensus definition for sarcopenia may however be at fault for much of our study limitations. The lack of consensus makes comparison of sarcopenia between studies extremely difficult, and furthermore our results may in fact conflict with others who have chosen to define sarcopenia differently. The same may be true for our research pertaining to obesity, with a wealth of classification systems available it becomes difficult to compare results from study to study.Moreover, our study participants were mostly relatively healthy, physically active, and as such our results are only generalizable to individuals in a similar situation. It would be extremely difficult to extrapolate our results to a population including extremely unhealthy, inactive individuals, as many of the relationships involved may be entirely different.Unfortunately we were not able to recruit as many participants as was initially desired, and were as such subject to problems associated with a small sample size. These problems were particularly evident upon classify individuals into sarcopenic obesity categories, and may have hindered our ability to detect differences between sarcopenic and obese populations, as a result of low statistical power. A greater number of participants would allow for much more in depth analysis, and a greater understanding of the factors relevant to participants classified into each category. A key limitation particularly important in sarcopenia’s relationship with obesity and bone health was the lack of hormonal measurements taken from participants. Hormonal measurements may have allowed for clarification of the mechanisms by which lean mass, or adipose mass may influence bone health in older adults.Future DirectionsFuture research in this area should be longitudinal in nature. This would allow for a shift in focus, from a single minded focus on low levels of mass and strength, to quantifiable levels of loss over the course of aging. As a result, individuals who are small and naturally weak in absolute terms may not be incorrectly classed as sarcopenic. This would allow for research to provide functional definitions that are more relevant to sarcopenia and its definition, of age related decline in muscle mass and strength. Longitudinal research will furthermore lead to the generation of better guidelines for the diagnosis of sarcopenia. Indeed they may develop to a standard where low levels of mass and strength becomes markers of decline in mass or strength respectively; offering the inference that an individual with certain measurements, must have seen decline to reach this lower level of functional ability. Moreover a wider range of more accurate guidelines will allow for sarcopenia being quantifiable at a clinical level, with the hopeful evolution to basic testing administered at a general practitioners clinic.ConclusionOur study has demonstrated that their still remains an intrinsic link between both muscle mass and strength measures, within the upper and lower body over the age of 50. Furthermore, strength measures are particularly important as a determinant of bone health, with upper body strength, namely in the arms a reliable indicator of whole-body bone density.ALM plays a role in determining bone health at a range of specific and whole body sites, whist the effect of obesity alone remains unclear. Obesity in some instances may mask the negative impact that low muscle mass and strength have upon bone health; however the relationship remains unclear and spasmodic.It is of the utmost importance that any weight loss regimes of the elderly recognise that lean mass and obesity may play a role in bone health maintenance. A decrease lean mass may be expected to result in a decline in bone health, and sufficient strength and resistance training should be undertaken to combat this ensuing decline.References ADDIN EN.REFLIST 1.Cardinet III GH. Skeletal muscle function. Clinical biochemistry of domestic animals. 1997;5:407-40.2.Baltzopoulos V, Gleeson NP. Skeletal muscle function. Kinanthropometry and exercise physiology laboratory manual. 2001:1.3.University College London. The Sliding Filament Theory 1997 [cited 2015 15/5/2015]. Available from: M, Baudry S, Duchateau J. Age-related decline in rate of torque development is accompanied by lower maximal motor unit discharge frequency during fast contractions. Journal of Applied Physiology. 2008;104(3):739-46.5.Sorock GS, Labiner DM. Peripheral neuromuscular dysfunction and falls in an elderly cohort. American journal of epidemiology. 1992;136(5):584-91.6.Stevens JE, Stackhouse SK, Binder‐Macleod SA, Snyder‐Mackler L. Are voluntary muscle activation deficits in older adults meaningful? Muscle & nerve. 2003;27(1):99-101.7.Martinez BP, Batista AK, Gomes IB, Olivieri FM, Camelier FW, Camelier AA. Frequency of sarcopenia and associated factors among hospitalized elderly patients. BMC musculoskeletal disorders. 2015;16(1):108.8.Yu J. The etiology and exercise implications of sarcopenia in the elderly. International Journal of Nursing Sciences. 2015.9.Han P, Kang L, Guo Q, Wang J, Zhang W, Shen S, et al. Prevalence and Factors Associated With Sarcopenia in Suburb-dwelling Older Chinese Using the Asian Working Group for Sarcopenia Definition. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2015:glv108.10.Tyrovolas S, Koyanagi A, Olaya B, Ayuso‐Mateos JL, Miret M, Chatterji S, et al. Factors associated with skeletal muscle mass, sarcopenia, and sarcopenic obesity in older adults: a multi‐continent study. Journal of Cachexia, Sarcopenia and Muscle. 2015.11.Park SW, Goodpaster BH, Strotmeyer ES, de Rekeneire N, Harris TB, Schwartz AV, et al. Decreased muscle strength and quality in older adults with type 2 diabetes The Health, Aging, and Body Composition Study. Diabetes. 2006;55(6):1813-8.12.Conroy MB, Kwoh CK, Krishnan E, Nevitt MC, Boudreau R, Carbone LD, et al. Muscle strength, mass, and quality in older men and women with knee osteoarthritis. Arthritis care & research. 2012;64(1):15-21.13.Metter EJ, Talbot LA, Schrager M, Conwit R. Skeletal muscle strength as a predictor of all-cause mortality in healthy men. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2002;57(10):B359-B65.14.Roubenoff R. Sarcopenic Obesity: Does Muscle Loss Cause Fat Gain?: Lessons from Rheumatoid Arthritis and Osteoarthritisa. Annals of the New York Academy of Sciences. 2000;904(1):553-7.15.Scott D, Sanders KM, Aitken D, Hayes A, Ebeling PR, Jones G. Sarcopenic obesity and dynapenic obesity: 5‐year associations with falls risk in middle‐aged and older adults. Obesity. 2014;22(6):1568-74.16.Martien S, Delecluse C, Boen F, Seghers J, Pelssers J, Van Hoecke A-S, et al. Is knee extension strength a better predictor of functional performance than handgrip strength among older adults in three different settings? Archives of gerontology and geriatrics. 2015;60(2):252-8.17.Leong DP, Teo KK, Rangarajan S, Lopez-Jaramillo P, Avezum A, Orlandini A, et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. The Lancet. 2015.18.Rantanen T, Harris T, Leveille SG, Visser M, Foley D, Masaki K, et al. Muscle strength and body mass index as long-term predictors of mortality in initially healthy men. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2000;55(3):M168-M73.19.Laukkanen P, Heikkinen E, Kauppinen M. Muscle strength and mobility as predictors of survival in 75–84-year-old people. Age and Ageing. 1995;24(6):468-73.20.Katzmarzyk P, Janssen I, Ardern C. Physical inactivity, excess adiposity and premature mortality. Obesity reviews. 2003;4(4):257-90.21.Webb AR, Newman LA, Taylor M, Keogh JB. Hand grip dynamometry as a predictor of postoperative complications reappraisal using age standardized grip strengths. Journal of Parenteral and Enteral Nutrition. 1989;13(1):30-3.22.Rantanen T, Guralnik JM, Foley D, Masaki K, Leveille S, Curb JD, et al. Midlife hand grip strength as a predictor of old age disability. Jama. 1999;281(6):558-60.23.Campbell AJ, Borrie MJ, Spears GF. Risk factors for falls in a community-based prospective study of people 70 years and older. Journal of gerontology. 1989;44(5):M112-M7.24.Landers KA, Hunter GR, Wetzstein CJ, Bamman MM, Weinsier RL. The interrelationship among muscle mass, strength, and the ability to perform physical tasks of daily living in younger and older women. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2001;56(10):B443-B8.25.Itoh S, Shirabe K, Yoshizumi T, Takeishi K, Harimoto N, Ikegami T, et al. Skeletal muscle mass assessed by computed tomography correlates with muscle strength and physical performance at a liver‐related hospital experience. Hepatology Research. 2015.26.Visser M. Obesity, sarcopenia and their functional consequences in old age. Proceedings of the Nutrition Society. 2011;70(01):114-8.27.Visser M, Goodpaster BH, Kritchevsky SB, Newman AB, Nevitt M, Rubin SM, et al. Muscle mass, muscle strength, and muscle fat infiltration as predictors of incident mobility limitations in well-functioning older persons. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2005;60(3):324-33.28.Visser M, Kritchevsky SB, Goodpaster BH, Newman AB, Nevitt M, Stamm E, et al. Leg muscle mass and composition in relation to lower extremity performance in men and women aged 70 to 79: the health, aging and body composition study. Journal of the American Geriatrics Society. 2002;50(5):897-904.29.Barbat-Artigas S, Pion CH, Leduc-Gaudet J-P, Rolland Y, Aubertin-Leheudre M. Exploring the role of muscle mass, obesity, and age in the relationship between muscle quality and physical function. Journal of the American Medical Directors Association. 2014;15(4):303. e13-. e20.30.DiBello JR, Miller R, Khandker R, Bourgeois N, Galwey N, Clark RV. Association between low muscle mass, functional limitations and hospitalisation in heart failure: NHANES 1999–2004. Age and ageing. 2015:afv129.31.Stephen W, Janssen I. Sarcopenic-obesity and cardiovascular disease risk in the elderly. JNHA-The Journal of Nutrition, Health and Aging. 2009;13(5):460-6.32.Goodpaster BH, Park SW, Harris TB, Kritchevsky SB, Nevitt M, Schwartz AV, et al. The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2006;61(10):1059-64.33.Cesari M, Pahor M, Lauretani F, Zamboni V, Bandinelli S, Bernabei R, et al. Skeletal muscle and mortality results from the InCHIANTI Study. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2009:gln031.34.Fukagawa NK, Wolfson L, Judge J, Whipple R, King M. Strength is a major factor in balance, gait, and the occurrence of falls. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 1995;50(Special Issue):64-7.35.Bouchard DR, Janssen I. Dynapenic-obesity and physical function in older adults. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2010;65(1):71-7.36.Rossi AP, Fantin F, Caliari C, Zoico E, Mazzali G, Zanardo M, et al. Dynapenic abdominal obesity as predictor of mortality and disability worsening in older adults: A 10-year prospective study. Clinical Nutrition. 2015.37.Reed R, Pearlmutter L, Yochum K, Meredith K, Mooradian A. The relationship between muscle mass and muscle strength in the elderly. Journal of the American Geriatrics Society. 1991;39(6):555-61.38.Frontera WR, Hughes VA, Fielding RA, Fiatarone MA, Evans WJ, Roubenoff R. Aging of skeletal muscle: a 12-yr longitudinal study. Journal of Applied Physiology. 2000;88(4):1321-6.39.Kim TN, Choi KM. Sarcopenia: Definition, Epidemiology, and Pathophysiology. Journal of Bone Metabolism. 2013;20(1):1-10.40.Kahn A, Holm-Pedersen P. Aging of bone and muscle. Textbook of Geriatric Dentistry. 2015:17.41.Morley JE, Baumgartner RN, Roubenoff R, Mayer J, Nair KS. Sarcopenia. Journal of Laboratory and Clinical Medicine. 2001;137(4):231-43.42.Chien Y-H, Lee N-C, Thurberg BL, Chiang S-C, Zhang XK, Keutzer J, et al. Pompe disease in infants: improving the prognosis by newborn screening and early treatment. Pediatrics. 2009;124(6):e1116-e25.43.Palmio J, Udd B. Borderlines between sarcopenia and mild late-onset muscle disease. Frontiers in aging neuroscience. 2014;6.44.Hutchins A. Is Age Related Muscle Loss Reversible: Runners World; 2014 [updated 25th February 2014; cited 2015 17/10/2015]. Available from: I. Summary comments. The American journal of clinical nutrition. 1989;50:1231-3.46.Cruz-Jentoft A, Baeyens J, Bauer J, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis. Age Aging. 2010;39(4):412-23.47.Clark B, Manini T. Sarcopenia =/= Dynapenia. Journals of Gerontology. 2008;63(8):829-34.48.Da Silva Alexandre T, Duarte YDO, Santos JF, Wong R, Lebr?o ML. Sarcopenia according to the European Working Group on Sarcopenia in Older People (EWGSOP) versus dynapenia as a risk factor for mortality in the elderly. The journal of nutrition, health & aging. 2014;18(8):751-6.49.Delmonico MJ, Harris TB, Lee JS, Visser M, Nevitt M, Kritchevsky SB, et al. Alternative definitions of sarcopenia, lower extremity performance, and functional impairment with aging in older men and women. Journal of the American Geriatrics Society. 2007;55(5):769-74.50.Clark B, Manini T. What is dynapenia? Nutrition. 2012;28(5):495-503.51.Clark B, Manini T. Functional Consequences of Sarcopenia and Dynapenia in the Elderly. Curent Opinion in Clinical Nutritional and Metabolic Care. 2010;13(3):271-6.52.Delmonico MJ, Harris TB, Visser M, Park SW, Conroy MB, Velasquez-Mieyer P, et al. Longitudinal study of muscle strength, quality, and adipose tissue infiltration. The American journal of clinical nutrition. 2009;90(6):1579-85.53.Caram MV, Bellile EL, Englesbe M, Terjimanian M, Wang SC, Griggs JJ, et al. Sarcopenia Is Associated with Autologous Transplant-Related Outcomes in Patients with Lymphoma. Leukemia & lymphoma. 2015(0):1-30.54.Bergerson JT, Lee JG, Furlan A, Sourianarayanane A, Fetzer DT, Tevar AD, et al. Liver transplantation arrests and reverses muscle wasting. Clinical transplantation. 2015;29(3):216-21.55.Huang C-Y, Hwang A-C, Liu L-K, Lee W-J, Chen L-Y, Peng L-N, et al. Association of Dynapenia, Sarcopenia and Cognitive Impairment among Community-Dwelling Older Taiwanese. Rejuvenation research. 2015(ja).56.Carias S, Castellanos AL, Vilchez V, Nair R, Dela Cruz A, Watkins J, et al. Non‐alcoholic steatohepatitis is strongly associated with sarcopenic obesity in patients with cirrhosis undergoing liver transplant evaluation. Journal of Gastroenterology and Hepatology. 2015.57.Moore DR, Churchward-Venne TA, Witard O, Breen L, Burd NA, Tipton KD, et al. Protein ingestion to stimulate myofibrillar protein synthesis requires greater relative protein intakes in healthy older versus younger men. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2015;70(1):57-62.58.Goodpaster BH, Chomentowski P, Ward BK, Rossi A, Glynn NW, Delmonico MJ, et al. Effects of physical activity on strength and skeletal muscle fat infiltration in older adults: a randomized controlled trial. Journal of Applied Physiology. 2008;105(5):1498-503.59.Evans WJ, Morley JE, Argilés J, Bales C, Baracos V, Guttridge D, et al. Cachexia: a new definition. Clinical nutrition. 2008;27(6):793-9.60.Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Comprehensive Physiology. 2012.61.Daniels SR. The consequences of childhood overweight and obesity. The future of children. 2006;16(1):47-67.62.Meng P, Hu YX, Fan L, Zhang Y, Zhang MX, Sun J, et al. Sarcopenia and sarcopenic obesity among men aged 80 years and older in Beijing: Prevalence and its association with functional performance. Geriatrics & gerontology international. 2014;14(S1):29-35.63.Sénéchal M, Dione I, Brochu M. Dynapenic abdominal obesity and Metabolic risk factors in Adults 50 years of age and older. Journal of Aging Health. 2012;24(5):812-26.64.Scott D, Ebeling P. Dynapenic Obesity, Muscoloskeletal and Cardiometabolic Health in Older Adults. Australian Institute for Muscolskeletal Science; The University of Melbourne2013.65.Guadalupe-Grau A, Fuentes T, Guerra B, Calbet JA. Exercise and bone mass in adults. Sports Medicine. 2009;39(6):439-68.66.Felson DT, Zhang Y, Hannan MT, Anderson JJ. Effects of weight and body mass index on bone mineral density in men and women: the Framingham study. Journal of Bone and Mineral Research. 1993;8(5):567-73.67.Edelstein SL, Barrett-Connor E. Relation between body size and bone mineral density in elderly men and women. American journal of epidemiology. 1993;138(3):160-9.68.Atkins JL, Whincup PH, Morris RW, Lennon LT, Papacosta O, Wannamethee SG. Sarcopenic Obesity and Risk of Cardiovascular Disease and Mortality: A Population‐Based Cohort Study of Older Men. Journal of the American Geriatrics Society. 2014;62(2):253-60.69.Ma J, Hwang S-J, McMahon GM, Curhan GC, McLean RR, Murabito JM, et al. Abstract P252: Sarcopenic Obesity is Associated With a High Burden of Cardiovascular Disease. Circulation. 2015;131(Suppl 1):AP252-AP.70.Montano‐Loza AJ, Angulo P, Meza‐Junco J, Prado CM, Sawyer MB, Beaumont C, et al. Sarcopenic obesity and myosteatosis are associated with higher mortality in patients with cirrhosis. Journal of Cachexia, Sarcopenia and Muscle. 2015.71.Australian Bureau of Statistics. Overweight/Obese: ABS; 2013 [cited 2015 15/4/2015]. Available from: S, Busetto L, Noale M, Limongi F, Crepaldi G. Obesity: Definition and Epidemiology. Multidisciplinary Approach to Obesity: Springer; 2015. p. 31-9.73.WHO. Obesity and Overweight World Health Organisation Media Centre2015 [updated January 2015; cited 2015 13/04/2015]. Available from: JC, Flegal KM. Assessing obesity: classification and epidemiology. British medical bulletin. 1997;53(2):238-52.75.Leonard C, Roza M, Barr R, Webber C. Reproducibility of DXA measurements of bone mineral density and body composition in children. Pediatr Radiol. 2009;39(2):148-54.76.Zoico E, Di Francesco V, Guralnik J, Mazzali G, Bortolani A, Guariento S, et al. Physical disability and muscular strength in relation to obesity and different body composition indexes in a sample of healthy elderly women. International journal of obesity. 2004;28(2):234-41.77.Davison KK, Ford ES, Cogswell ME, Dietz WH. Percentage of body fat and body mass index are associated with mobility limitations in people aged 70 and older from NHANES III. Journal of the American Geriatrics Society. 2002;50(11):1802-9.78.Baumgartner RN, Wayne SJ, Waters DL, Janssen I, Gallagher D, Morley JE. Sarcopenic obesity predicts instrumental activities of daily living disability in the elderly. Obesity research. 2004;12(12):1995-2004.79.Baumgartner RN, Koehler KM, Gallagher D, Romero L, Heymsfield SB, Ross RR, et al. Epidemiology of sarcopenia among the elderly in New Mexico. American journal of epidemiology. 1998;147(8):755-63.80.Dufour AB, Hannan MT, Murabito JM, Kiel DP, McLean RR. Sarcopenia definitions considering body size and fat mass are associated with mobility limitations: the Framingham Study. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2012:gls109.81.Evans E, Rowe D, Racette S, Ross K, McAuley E. Is the current BMI obesity classification appropriate for black and white postmenopausal women? International Journal of Obesity. 2006;30(5):837-43.82.Rahman M, Berenson AB. Accuracy of current body mass index obesity classification for white, black and Hispanic reproductive-age women. Obstetrics and gynecology. 2010;115(5):982.83.Kêkê L, Samouda H, Jacobs J, di Pompeo C, Lemdani M, Hubert H, et al. Body mass index and childhood obesity classification systems: A comparison of the French, International Obesity Task Force (IOTF) and World Health Organization (WHO) references. Revue d'epidemiologie et de sante publique. 2015.84.Carter DR, Beaupré GS. Skeletal function and form: mechanobiology of skeletal development, aging, and regeneration: Cambridge University Press; 2007.85.Rodan GA. The development and function of the skeleton and bone metastases. Cancer. 2003;97(S3):726-32.86.Buckwalter J, Cooper R. Bone structure and function. Instructional course lectures. 1986;36:27-48.87.Cullinane D. The role of osteocytes in bone regulation: mineral homeostasis versus mechanoreception. Journal of Musculoskeletal and Neuronal Interactions. 2002;2(3):242-4.88.Erlebacher A, Derynck R. Increased expression of TGF-beta 2 in osteoblasts results in an osteoporosis-like phenotype. The Journal of cell biology. 1996;132(1):195-210.89.Barbour KE, Zmuda JM, Strotmeyer ES, Horwitz MJ, Boudreau R, Evans RW, et al. Correlates of trabecular and cortical volumetric bone mineral density of the radius and tibia in older men: the Osteoporotic Fractures in Men Study. Journal of Bone and Mineral Research. 2010;25(5):1017-28.90.Mather J, MacDermid JC, Faber KJ, Athwal GS. Proximal humerus cortical bone thickness correlates with bone mineral density and can clinically rule out osteoporosis. Journal of Shoulder and Elbow Surgery. 2013;22(6):732-8.91.Meema H, MEEMA S. CORTICAL BONE MINERAL DENSITY VERSUS CORTICAL THICKNESS IN THE DIAGNOSIS OF OSTEOPOROSIS: A ROENTGENOLOGIC‐DENSITOMETRIC STUDY*. Journal of the American Geriatrics Society. 1969;17(2):120-41.92.Majumdar S, Genant H, Grampp S, Newitt D, Truong VH, Lin J, et al. Correlation of trabecular bone structure with age, bone mineral density, and osteoporotic status: in vivo studies in the distal radius using high resolution magnetic resonance imaging. Journal of Bone and Mineral Research. 1997;12(1):111-8.93.Lorentzon M, Mellstrom D, Haug E, Ohlsson C. Smoking is associated with lower bone mineral density and reduced cortical thickness in young men. The Journal of clinical endocrinology & metabolism. 2007;92(2):497-503.94.Gnudi S, Sitta E, Fiumi N. Bone density and geometry in assessing hip fracture risk in post-menopausal women. The British journal of radiology. 2014.95.Heinonen A, Oja P, Kannus P, Siev?nen H, M?ntt?ri A, Vuori I. Bone mineral density of female athletes in different sports. Bone and mineral. 1993;23(1):1-14.96.Taaffe DR, Snow‐Harter C, Connolly DA, Robinson TL, Brown MD, Marcus R. Differential effects of swimming versus weight‐bearing activity on bone mineral status of eumenorrheic athletes. Journal of Bone and Mineral Research. 1995;10(4):586-93.97.Brahm H, Str?m H, Piehl-Aulin K, Mallmin H, Ljunghall S. Bone metabolism in endurance trained athletes: a comparison to population-based controls based on DXA, SXA, quantitative ultrasound, and biochemical markers. Calcified tissue international. 1997;61(6):448-54.98.Chien M, Wu Y, Hsu A-T, Yang R, Lai J. Efficacy of a 24-week aerobic exercise program for osteopenic postmenopausal women. Calcified Tissue International. 2000;67(6):443-8.99.Bouxsein ML, Marcus R. Overview of exercise and bone mass. Rheumatic diseases clinics of North America. 1994;20(3):787-802.100.Lee I-M, Sesso HD, Chen J-J, Paffenbarger Jr RS. Does physical activity play a role in the prevention of prostate cancer? Epidemiologic reviews. 2014;23(1):132-7.101.DeLany JP, Kelley DE, Hames KC, Jakicic JM, Goodpaster BH. Effect of physical activity on weight loss, energy expenditure, and energy intake during diet induced weight loss. Obesity. 2014;22(2):363-70.102.Maddocks M, Shrikrishna D, Vitoriano S, Natanek SA, Tanner RJ, Hart N, et al. Skeletal muscle adiposity is associated with physical activity, exercise capacity and fibre shift in COPD. European Respiratory Journal. 2014;44(5):1188-98.103.Addison O, Marcus RL, LaStayo PC, Ryan AS. Intermuscular fat: a review of the consequences and causes. International journal of endocrinology. 2014;2014.104.Therkelsen KE, Pedley A, Hoffman U, Fox C, Murabito J. Abstract MP77: Intramuscular Fat is Associated with Decreased Physical Performance. Circulation. 2015;131(Suppl 1):AMP77-AMP.105.Liu CK, Leng X, Hsu F-C, Kritchevsky S, Ding J, Earnest C, et al. The impact of sarcopenia on a physical activity intervention: the Lifestyle Interventions and Independence for Elders Pilot Study (LIFE-P). The journal of nutrition, health & aging. 2014;18(1):59-64.106.Cvecka J, Tirpakova V, Sedliak M, Kern H, Mayr W, Hamar D. Physical activity in elderly. European Journal of Translational Myology. 2015;25(4):249-52.107.Walsh MC, Hunter GR, Livingstone MB. Sarcopenia in premenopausal and postmenopausal women with osteopenia, osteoporosis and normal bone mineral density. Osteoporosis International. 2006;17(1):61-7.108.Mazess RB, Barden HS, Bisek JP, Hanson J. Dual-energy x-ray absorptiometry for total-body and regional bone-mineral and soft-tissue composition. The American journal of clinical nutrition. 1990;51(6):1106-12.109.Bevier WC, Wiswell RA, Pyka G, Kozak KC, Newhall KM, Marcus R. Relationship of body composition, muscle strength, and aerobic capacity to bone mineral density in older men and women. Journal of bone and mineral research. 1989;4(3):421-32.110.Snow‐Harter C, Bouxsein M, Lewis B, Charette S, Weinstein P, Marcus R. Muscle strength as a predictor of bone mineral density in young women. Journal of Bone and Mineral Research. 1990;5(6):589-95.111.Pasco JA, Holloway KL, Brennan-Olsen SL, Moloney DJ, Kotowicz MA. Muscle strength and areal bone mineral density at the hip in women: a cross-sectional study. BMC musculoskeletal disorders. 2015;16(1):124.112.Ahima RS, Flier JS. Adipose tissue as an endocrine organ. Trends in Endocrinology & Metabolism. 2000;11(8):327-32.113.Kershaw EE, Flier JS. Adipose tissue as an endocrine organ. The Journal of Clinical Endocrinology & Metabolism. 2004;89(6):2548-56.114.Ailhaud G. Adipose tissue as an endocrine organ. International journal of obesity and related metabolic disorders: journal of the International Association for the Study of Obesity. 2000;24:S1-3.115.Galic S, Oakhill JS, Steinberg GR. Adipose tissue as an endocrine organ. Molecular and cellular endocrinology. 2010;316(2):129-39.116.Mohamed-Ali V, Pinkney J, Coppack S. Adipose tissue as an endocrine and paracrine organ. International journal of obesity. 1998;22:1145-58.117.Prins JB. Adipose tissue as an endocrine organ. Best Practice & Research Clinical Endocrinology & Metabolism. 2002;16(4):639-51.118.Jang C, Inder WJ, Obeyesekere VR, Alford FP. Adiponectin, skeletal muscle adiponectin receptor expression and insulin resistance following dexamethasone. Clinical endocrinology. 2008;69(5):745-50.119.Ingelsson E, Arnlov J, Zethelius B, Vasan RS, Flyvbjerg A, Frystyk J, et al. Associations of serum adiponectin with skeletal muscle morphology and insulin sensitivity. The Journal of Clinical Endocrinology & Metabolism. 2009;94(3):953-7.120.Shinoda Y, Yamaguchi M, Ogata N, Akune T, Kubota N, Yamauchi T, et al. Regulation of bone formation by adiponectin through autocrine/paracrine and endocrine pathways. Journal of cellular biochemistry. 2006;99(1):196-208.121.DiaSorin. LIAISON 25 OH Vitamin D TOTAL Assay 2013:1-9.122.Siemens. Glucose Hexokinase_3 (GLUH_3). 2012.123.Siemens. Triglycerides. 2011.124.Siemens. Wide Range C-Reactive Protein. 2011.125.González‐Gay MA, Llorca J, González‐Juanatey C, Dessein PH. Is the homeostatic model assessment of insulin resistance (HOMA‐IR) a poor predictor of cardiovascular disease in rheumatoid arthritis? Arthritis & Rheumatology. 2015.126.Shaban N, Kenno K, Milne K. The effects of a 2 week modified high intensity interval training program on the homeostatic model of insulin resistance (HOMA-IR) in adults with type 2 diabetes. The Journal of sports medicine and physical fitness. 2014;54(2):203-9.127.Shaw K, Srikanth V, Fryer J, Blizzard L, Dwyer T, Venn A. Dual energy X-ray absorptiometry body composition and aging in a population-based older cohort. International journal of obesity. 2007;31(2):279-84.128.WHO Expert Consultation. Waist circumference and waist-hip ratio. 2011.129.Dalton M, Cameron A, Zimmet P, Shaw J, Jolley D, Dunstan D, et al. Waist circumference, waist–hip ratio and body mass index and their correlation with cardiovascular disease risk factors in Australian adults. Journal of internal medicine. 2003;254(6):555-63.130.Visscher T, Seidell J, Molarius A, van der Kuip D, Hofman A, Witteman J. A comparison of body mass index, waist-hip ratio and waist circumference as predictors of all-cause mortality among the elderly: the Rotterdam study. International journal of obesity and related metabolic disorders: journal of the International Association for the Study of Obesity. 2001;25(11):1730-5.131.Wei M, Gaskill SP, Haffner SM, Stern MP. Waist Circumference as the Best Predictor of Noninsulin Dependent Diabetes Mellitus (NIDDM) Compared to Body Mass Index, Waist/hip Ratio and Other Anthropometric Measurements in Mexican Americans—A 7‐Year Prospective Study. Obesity research. 1997;5(1):16-23.132.Nieto-Garcia FJ, Bush TL, Keyl PM. Body mass definitions of obesity: sensitivity and specificity using self-reported weight and height. Epidemiology. 1990:146-52.133.Wolf AM, Hunter DJ, Colditz GA, Manson JE, Stampfer MJ, Corsano KA, et al. Reproducibility and validity of a self-administered physical activity questionnaire. International journal of epidemiology. 1994;23(5):991-9.134.Dominick KL, Ahern FM, Gold CH, Heller DA. Relationship of health-related quality of life to health care utilization and mortality among older adults. Aging clinical and experimental research. 2002;14(6):499-508.135.Brown WJ, Burton NW, Marshall AL, Miller YD. Reliability and validity of a modified self‐administered version of the Active Australia physical activity survey in a sample of mid‐age women. Australian and New Zealand journal of public health. 2008;32(6):535-41.136.Cargill J, Lucas RM, Gies P, King K, Swaminathan A, Allen MW, et al. Validation of brief questionnaire measures of sun exposure and skin pigmentation against detailed and objective measures including vitamin D status. Photochemistry and photobiology. 2013;89(1):219-26.137.Slater CH, Bick D. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation. JAMA. 1994;271(17):1377-.138.Osborne RH, Hawthorne G, Lew EA, Gray LC. Quality of life assessment in the community-dwelling elderly: validation of the Assessment of Quality of Life (AQoL) Instrument and comparison with the SF-36. Journal of clinical epidemiology. 2003;56(2):138-47.139.Howland J, Lachman ME, Peterson EW, Cote J, Kasten L, Jette A. Covariates of fear of falling and associated activity curtailment. The Gerontologist. 1998;38(5):549-55.140.Tinetti ME, De Leon CFM, Doucette JT, Baker DI. Fear of falling and fall-related efficacy in relationship to functioning among community-living elders. Journal of gerontology. 1994;49(3):M140-M7.141.Hill KD, Schwarz JA, Kalogeropoulos AJ, Gibson SJ. Fear of falling revisited. Archives of physical medicine and rehabilitation. 1996;77(10):1025-9.142.Kempen GI, Todd CJ, Van Haastregt JC, Rixt Zijlstra G, Beyer N, Freiberger E, et al. Cross-cultural validation of the Falls Efficacy Scale International (FES-I) in older people: results from Germany, the Netherlands and the UK were satisfactory. Disability & Rehabilitation. 2007;29(2):155-62.143.WHO. WHO Scientific Group on the Assessment of Osteoporosis at Primary Health Care Level. Belgium, Brussels: 2004 5-7/5/2004. Report No.144.Blake GM, Fogelman I. The role of DXA bone density scans in the diagnosis and treatment of osteoporosis. Postgraduate medical journal. 2007;83(982):509-17.145.Li N, Li X-m, Xu L, Sun W-j, Cheng X-g, Tian W. Comparison of QCT and DXA: osteoporosis detection rates in postmenopausal women. International journal of endocrinology. 2013;2013.146.Dowthwaite JN, Flowers PP, Scerpella TA. Agreement between pQCT‐and DXA‐derived indices of bone geometry, density, and theoretical strength in females of varying age, maturity, and physical activity. Journal of Bone and Mineral Research. 2011;26(6):1349-57.147.Muller A, Ruegsegger E, Ruegsegger P. Peripheral QCT: a low-risk procedure to identify women predisposed to osteoporosis. Physics in medicine and biology. 1989;34(6):741.148.Kontulainen S, Johnston J, Liu D, Leung C, Oxland T, McKay H. Strength indices from pQCT imaging predict up to 85% of variance in bone failure properties at tibial epiphysis and diaphysis. J Musculoskelet Neuronal Interact. 2008;8(4):401-9.149.Tournis S, Antoniou JD, Liakou CG, Christodoulou J, Papakitsou E, Galanos A, et al. Volumetric bone mineral density and bone geometry assessed by peripheral quantitative computed tomography in women with differentiated thyroid cancer under TSH suppression. Clinical endocrinology. 2015;82(2):197-204.150.New World Encyclopaedia. Computed Tomography: New World Encyclopaedia,; 2013 [updated 11/06/2013; cited 2015 26/05/2015]. Available from: TM, Clark BC, Nalls MA, Goodpaster BH, Ploutz-Snyder LL, Harris TB. Reduced physical activity increases intermuscular adipose tissue in healthy young adults. The American journal of clinical nutrition. 2007;85(2):377-84.152.Roberts HC, Denison HJ, Martin HJ, Patel HP, Syddall H, Cooper C, et al. A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age and ageing. 2011:afr051.153.Lang IA, Llewellyn DJ, Alexander K, Melzer D. Obesity, physical function, and mortality in older adults. Journal of the American Geriatrics Society. 2008;56(8):1474-8.154.Rogers ME, Rogers NL, Takeshima N, Islam MM. Methods to assess and improve the physical parameters associated with fall risk in older adults. Preventive medicine. 2003;36(3):255-64.155.Ostir GV, Kuo Y-F, Berges IM, Markides KS, Ottenbacher KJ. Measures of lower body function and risk of mortality over 7 years of follow-up. American journal of epidemiology. 2007;166(5):599-605.156.CDC. The 4-Stage Balance Test2015 13/04/2015. Available from: RA, Bryant AL, Pua Y, McCrory P, Bennell K, Hunt M. Validity and reliability of the Nintendo Wii Balance Board for assessment of standing balance. Gait & posture. 2010;31(3):307-10.158.Batsis JA, Mackenzie TA, Lopez-Jimenez F, Bartels SJ. Sarcopenia, Sarcopenic Obesity and Functional Impairments in Older Adults: NHANES 1999-2004. Nutrition Research. 2015.159.Auyeung TW, Lee SWJ, Leung J, Kwok T, Woo J. Age‐associated decline of muscle mass, grip strength and gait speed: A 4‐year longitudinal study of 3018 community‐dwelling older Chinese. Geriatrics & gerontology international. 2014;14(S1):76-84.160.Hasegawa Y, Schneider P, Reiners C. Age, sex, and grip strength determine architectural bone parameters assessed by peripheral quantitative computed tomography (pQCT) at the human radius. Journal of biomechanics. 2001;34(4):497-503.161.Szulc P, Blaizot S, Boutroy S, Vilayphiou N, Boonen S, Chapurlat R. Impaired bone microarchitecture at the distal radius in older men with low muscle mass and grip strength: the STRAMBO study. Journal of Bone and Mineral Research. 2013;28(1):169-78.162.Frost HM. The Utah paradigm of skeletal physiology: an overview of its insights for bone, cartilage and collagenous tissue organs. Journal of bone and mineral metabolism. 2000;18(6):305-16.163.Frost H. The Utah Paradigm of Skeletal Physiology Vol. 1. ISMNI [1]. 1960.164.Dodds RA, Connor JR, James IE, Lee Rykaczewski E, Appelbaum E, Dul E, et al. Human osteoclasts, not osteoblasts, deposit osteopontin onto resorption surfaces: an in vitro and ex vivo study of remodeling bone. Journal of Bone and Mineral Research. 1995;10(11):1666-80.165.Jerez S, Chen B. Stability analysis of a Komarova type model for the interactions of osteoblast and osteoclast cells during bone remodeling. Mathematical biosciences. 2015;264:29-37.166.Grimston SK, Willows ND, Hanley DA. Mechanical loading regime and its relationship to bone mineral density in children. Medicine and science in sports and exercise. 1993;25(11):1203-10.167.Holick MF. Perspective on the impact of weightlessness on calcium and bone metabolism. Bone. 1998;22(5):105S-11S.168.Kaji H, Kosaka R, YAMAUCHI M, KUNO K, CHIHARA K, SUGIMOTO T. Effects of age, grip strength and smoking on forearm volumetric bone mineral density and bone geometry by peripheral quantitative computed tomography: comparisons between female and male. Endocrine journal. 2005;52(6):659-66.169.Bousson Va, Le Le Bras A, Roqueplan F, Kang Y, Mitton D, Kolta S, et al. Volumetric quantitative computed tomography of the proximal femur: relationships linking geometric and densitometric variables to bone strength. Role for compact bone. Osteoporosis international. 2006;17(6):855-64.170.Kelsey JL, Browner WS, Seeley DG, Nevitt MC, Cummings SR. Risk factors for fractures of the distal forearm and proximal humerus. American Journal of Epidemiology. 1992;135(5):477-89.171.Leslie WD, Orwoll ES, Nielson CM, Morin SN, Majumdar SR, Johansson H, et al. Estimated lean mass and fat mass differentially affect femoral bone density and strength index but are not FRAX independent risk factors for fracture. Journal of Bone and Mineral Research. 2014;29(11):2511-9.172.Wang M, Bachrach L, Van Loan M, Hudes M, Flegal K, Crawford P. The relative contributions of lean tissue mass and fat mass to bone density in young women. Bone. 2005;37(4):474-81.173.Seeman E. Pathogenesis of bone fragility in women and men. The Lancet. 2002;359(9320):1841-50.174.Frost HM, Sch?nau E. The" muscle-bone unit" in children and adolescents: a 2000 overview. Journal of Pediatric Endocrinology and Metabolism. 2000;13(6):571-90.175.Reid IR. Relationships among body mass, its components, and bone. BoneKEy-Osteovision. 2002.176.Thomas T. Leptin: a potential mediator for protective effects of fat mass on bone tissue. Joint Bone Spine. 2003;70(1):18-21.177.Short K, Nair K. Mechanisms of sarcopenia of aging. Journal of endocrinological investigation. 1998;22(5 Suppl):95-105.178.Young N, Formica C, Szmukler G, Seeman E. Bone density at weight-bearing and nonweight-bearing sites in ballet dancers: the effects of exercise, hypogonadism, and body weight. The Journal of Clinical Endocrinology & Metabolism. 1994;78(2):449-54.179.Oshima K, Nampei A, Matsuda M, Iwaki M, Fukuhara A, Hashimoto J, et al. Adiponectin increases bone mass by suppressing osteoclast and activating osteoblast. Biochemical and biophysical research communications. 2005;331(2):520-6.180.Berner HS, Lyngstadaas SP, Spahr A, Monjo M, Thommesen L, Drevon CA, et al. Adiponectin and its receptors are expressed in bone-forming cells. Bone. 2004;35(4):842-9.181.Reid I. Relationships between fat and bone. Osteoporosis International. 2008;19(5):595-606.182.Rosen CJ, Bouxsein ML. Mechanisms of disease: is osteoporosis the obesity of bone? Nature Clinical Practice Rheumatology. 2006;2(1):35-43.183.Goodpaster BH, Carlson CL, Visser M, Kelley DE, Scherzinger A, Harris TB, et al. Attenuation of skeletal muscle and strength in the elderly: The Health ABC Study. Journal of Applied Physiology. 2001;90(6):2157-65. ADDIN EN.REFLIST 1.Cardinet III GH. Skeletal muscle function. Clinical biochemistry of domestic animals. 1997;5:407-40.2.Baltzopoulos V, Gleeson NP. Skeletal muscle function. Kinanthropometry and exercise physiology laboratory manual. 2001:1.3.University College London. The Sliding Filament Theory 1997 [cited 2015 15/5/2015]. Available from: M, Baudry S, Duchateau J. Age-related decline in rate of torque development is accompanied by lower maximal motor unit discharge frequency during fast contractions. Journal of Applied Physiology. 2008;104(3):739-46.5.Sorock GS, Labiner DM. Peripheral neuromuscular dysfunction and falls in an elderly cohort. American journal of epidemiology. 1992;136(5):584-91.6.Stevens JE, Stackhouse SK, Binder‐Macleod SA, Snyder‐Mackler L. Are voluntary muscle activation deficits in older adults meaningful? Muscle & nerve. 2003;27(1):99-101.7.Martinez BP, Batista AK, Gomes IB, Olivieri FM, Camelier FW, Camelier AA. Frequency of sarcopenia and associated factors among hospitalized elderly patients. BMC musculoskeletal disorders. 2015;16(1):108.8.Yu J. The etiology and exercise implications of sarcopenia in the elderly. International Journal of Nursing Sciences. 2015.9.Han P, Kang L, Guo Q, Wang J, Zhang W, Shen S, et al. Prevalence and Factors Associated With Sarcopenia in Suburb-dwelling Older Chinese Using the Asian Working Group for Sarcopenia Definition. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2015:glv108.10.Tyrovolas S, Koyanagi A, Olaya B, Ayuso‐Mateos JL, Miret M, Chatterji S, et al. Factors associated with skeletal muscle mass, sarcopenia, and sarcopenic obesity in older adults: a multi‐continent study. Journal of Cachexia, Sarcopenia and Muscle. 2015.11.Park SW, Goodpaster BH, Strotmeyer ES, de Rekeneire N, Harris TB, Schwartz AV, et al. Decreased muscle strength and quality in older adults with type 2 diabetes The Health, Aging, and Body Composition Study. Diabetes. 2006;55(6):1813-8.12.Conroy MB, Kwoh CK, Krishnan E, Nevitt MC, Boudreau R, Carbone LD, et al. Muscle strength, mass, and quality in older men and women with knee osteoarthritis. Arthritis care & research. 2012;64(1):15-21.13.Metter EJ, Talbot LA, Schrager M, Conwit R. Skeletal muscle strength as a predictor of all-cause mortality in healthy men. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2002;57(10):B359-B65.14.Roubenoff R. Sarcopenic Obesity: Does Muscle Loss Cause Fat Gain?: Lessons from Rheumatoid Arthritis and Osteoarthritisa. Annals of the New York Academy of Sciences. 2000;904(1):553-7.15.Scott D, Sanders KM, Aitken D, Hayes A, Ebeling PR, Jones G. Sarcopenic obesity and dynapenic obesity: 5‐year associations with falls risk in middle‐aged and older adults. Obesity. 2014;22(6):1568-74.16.Martien S, Delecluse C, Boen F, Seghers J, Pelssers J, Van Hoecke A-S, et al. Is knee extension strength a better predictor of functional performance than handgrip strength among older adults in three different settings? Archives of gerontology and geriatrics. 2015;60(2):252-8.17.Leong DP, Teo KK, Rangarajan S, Lopez-Jaramillo P, Avezum A, Orlandini A, et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. The Lancet. 2015.18.Rantanen T, Harris T, Leveille SG, Visser M, Foley D, Masaki K, et al. Muscle strength and body mass index as long-term predictors of mortality in initially healthy men. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2000;55(3):M168-M73.19.Laukkanen P, Heikkinen E, Kauppinen M. Muscle strength and mobility as predictors of survival in 75–84-year-old people. Age and Ageing. 1995;24(6):468-73.20.Katzmarzyk P, Janssen I, Ardern C. Physical inactivity, excess adiposity and premature mortality. Obesity reviews. 2003;4(4):257-90.21.Webb AR, Newman LA, Taylor M, Keogh JB. Hand grip dynamometry as a predictor of postoperative complications reappraisal using age standardized grip strengths. Journal of Parenteral and Enteral Nutrition. 1989;13(1):30-3.22.Rantanen T, Guralnik JM, Foley D, Masaki K, Leveille S, Curb JD, et al. Midlife hand grip strength as a predictor of old age disability. Jama. 1999;281(6):558-60.23.Campbell AJ, Borrie MJ, Spears GF. Risk factors for falls in a community-based prospective study of people 70 years and older. Journal of gerontology. 1989;44(5):M112-M7.24.Bouchard DR, Janssen I. Loss of Muscle Mass and Muscle Strength in Obese and Nonobese Older Adults. Handbook of Clinical Nutrition and Aging: Springer; 2015. p. 99-111.25.DiBello JR, Miller R, Khandker R, Bourgeois N, Galwey N, Clark RV. Association between low muscle mass, functional limitations and hospitalisation in heart failure: NHANES 1999–2004. Age and ageing. 2015:afv129.26.Goodpaster BH, Park SW, Harris TB, Kritchevsky SB, Nevitt M, Schwartz AV, et al. The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2006;61(10):1059-64.27.Houston DK, Nicklas BJ, Ding J, Harris TB, Tylavsky FA, Newman AB, et al. Dietary protein intake is associated with lean mass change in older, community-dwelling adults: the Health, Aging, and Body Composition (Health ABC) Study. The American Journal of Clinical Nutrition. 2008;87(1):150-5.28.Landers KA, Hunter GR, Wetzstein CJ, Bamman MM, Weinsier RL. The interrelationship among muscle mass, strength, and the ability to perform physical tasks of daily living in younger and older women. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2001;56(10):B443-B8.29.Itoh S, Shirabe K, Yoshizumi T, Takeishi K, Harimoto N, Ikegami T, et al. Skeletal muscle mass assessed by computed tomography correlates with muscle strength and physical performance at a liver‐related hospital experience. Hepatology Research. 2015.30.Visser M. Obesity, sarcopenia and their functional consequences in old age. Proceedings of the Nutrition Society. 2011;70(01):114-8.31.Visser M, Goodpaster BH, Kritchevsky SB, Newman AB, Nevitt M, Rubin SM, et al. Muscle mass, muscle strength, and muscle fat infiltration as predictors of incident mobility limitations in well-functioning older persons. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2005;60(3):324-33.32.Visser M, Kritchevsky SB, Goodpaster BH, Newman AB, Nevitt M, Stamm E, et al. Leg muscle mass and composition in relation to lower extremity performance in men and women aged 70 to 79: the health, aging and body composition study. Journal of the American Geriatrics Society. 2002;50(5):897-904.33.Barbat-Artigas S, Pion CH, Leduc-Gaudet J-P, Rolland Y, Aubertin-Leheudre M. Exploring the role of muscle mass, obesity, and age in the relationship between muscle quality and physical function. Journal of the American Medical Directors Association. 2014;15(4):303. e13-. e20.34.Stephen W, Janssen I. Sarcopenic-obesity and cardiovascular disease risk in the elderly. JNHA-The Journal of Nutrition, Health and Aging. 2009;13(5):460-6.35.Cesari M, Pahor M, Lauretani F, Zamboni V, Bandinelli S, Bernabei R, et al. Skeletal muscle and mortality results from the InCHIANTI Study. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2009:gln031.36.Fukagawa NK, Wolfson L, Judge J, Whipple R, King M. Strength is a major factor in balance, gait, and the occurrence of falls. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 1995;50(Special Issue):64-7.37.Bouchard DR, Janssen I. Dynapenic-obesity and physical function in older adults. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2010;65(1):71-7.38.Rossi AP, Fantin F, Caliari C, Zoico E, Mazzali G, Zanardo M, et al. Dynapenic abdominal obesity as predictor of mortality and disability worsening in older adults: A 10-year prospective study. Clinical Nutrition. 2015.39.Reed R, Pearlmutter L, Yochum K, Meredith K, Mooradian A. The relationship between muscle mass and muscle strength in the elderly. Journal of the American Geriatrics Society. 1991;39(6):555-61.40.Frontera WR, Hughes VA, Fielding RA, Fiatarone MA, Evans WJ, Roubenoff R. Aging of skeletal muscle: a 12-yr longitudinal study. Journal of Applied Physiology. 2000;88(4):1321-6.41.Kim TN, Choi KM. Sarcopenia: Definition, Epidemiology, and Pathophysiology. Journal of Bone Metabolism. 2013;20(1):1-10.42.Kahn A, Holm-Pedersen P. Aging of bone and muscle. Textbook of Geriatric Dentistry. 2015:17.43.Morley JE, Baumgartner RN, Roubenoff R, Mayer J, Nair KS. Sarcopenia. Journal of Laboratory and Clinical Medicine. 2001;137(4):231-43.44.Palmio J, Udd B. Borderlines between sarcopenia and mild late-onset muscle disease. Frontiers in aging neuroscience. 2014;6.45.Hutchins A. Is Age Related Muscle Loss Reversible: Runners World; 2014 [updated 25th February 2014; cited 2015 17/10/2015]. Available from: I. Summary comments. The American journal of clinical nutrition. 1989;50:1231-3.47.Clark B, Manini T. Sarcopenia =/= Dynapenia. Journals of Gerontology. 2008;63(8):829-34.48.Clark B, Manini T. What is dynapenia? Nutrition. 2012;28(5):495-503.49.Clark B, Manini T. Functional Consequences of Sarcopenia and Dynapenia in the Elderly. Curent Opinion in Clinical Nutritional and Metabolic Care. 2010;13(3):271-6.50.Delmonico MJ, Harris TB, Visser M, Park SW, Conroy MB, Velasquez-Mieyer P, et al. Longitudinal study of muscle strength, quality, and adipose tissue infiltration. The American journal of clinical nutrition. 2009;90(6):1579-85.51.Cruz-Jentoft A, Baeyens J, Bauer J, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis. Age Aging. 2010;39(4):412-23.52.Da Silva Alexandre T, Duarte YDO, Santos JF, Wong R, Lebr?o ML. Sarcopenia according to the European Working Group on Sarcopenia in Older People (EWGSOP) versus dynapenia as a risk factor for mortality in the elderly. The journal of nutrition, health & aging. 2014;18(8):751-6.53.Delmonico MJ, Harris TB, Lee JS, Visser M, Nevitt M, Kritchevsky SB, et al. Alternative definitions of sarcopenia, lower extremity performance, and functional impairment with aging in older men and women. Journal of the American Geriatrics Society. 2007;55(5):769-74.54.Caram MV, Bellile EL, Englesbe M, Terjimanian M, Wang SC, Griggs JJ, et al. Sarcopenia Is Associated with Autologous Transplant-Related Outcomes in Patients with Lymphoma. Leukemia & lymphoma. 2015(0):1-30.55.Bergerson JT, Lee JG, Furlan A, Sourianarayanane A, Fetzer DT, Tevar AD, et al. Liver transplantation arrests and reverses muscle wasting. Clinical transplantation. 2015;29(3):216-21.56.Huang C-Y, Hwang A-C, Liu L-K, Lee W-J, Chen L-Y, Peng L-N, et al. Association of Dynapenia, Sarcopenia and Cognitive Impairment among Community-Dwelling Older Taiwanese. Rejuvenation research. 2015(ja).57.Carias S, Castellanos AL, Vilchez V, Nair R, Dela Cruz A, Watkins J, et al. Non‐alcoholic steatohepatitis is strongly associated with sarcopenic obesity in patients with cirrhosis undergoing liver transplant evaluation. Journal of Gastroenterology and Hepatology. 2015.58.Moore DR, Churchward-Venne TA, Witard O, Breen L, Burd NA, Tipton KD, et al. Protein ingestion to stimulate myofibrillar protein synthesis requires greater relative protein intakes in healthy older versus younger men. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2015;70(1):57-62.59.Goodpaster BH, Chomentowski P, Ward BK, Rossi A, Glynn NW, Delmonico MJ, et al. Effects of physical activity on strength and skeletal muscle fat infiltration in older adults: a randomized controlled trial. Journal of Applied Physiology. 2008;105(5):1498-503.60.Evans WJ, Morley JE, Argilés J, Bales C, Baracos V, Guttridge D, et al. Cachexia: a new definition. Clinical nutrition. 2008;27(6):793-9.61.Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Comprehensive Physiology. 2012.62.Daniels SR. The consequences of childhood overweight and obesity. The future of children. 2006;16(1):47-67.63.Meng P, Hu YX, Fan L, Zhang Y, Zhang MX, Sun J, et al. Sarcopenia and sarcopenic obesity among men aged 80 years and older in Beijing: Prevalence and its association with functional performance. Geriatrics & gerontology international. 2014;14(S1):29-35.64.Sénéchal M, Dione I, Brochu M. Dynapenic abdominal obesity and Metabolic risk factors in Adults 50 years of age and older. Journal of Aging Health. 2012;24(5):812-26.65.Scott D, Ebeling P. Dynapenic Obesity, Muscoloskeletal and Cardiometabolic Health in Older Adults. Australian Institute for Muscolskeletal Science; The University of Melbourne2013.66.Guadalupe-Grau A, Fuentes T, Guerra B, Calbet JA. Exercise and bone mass in adults. Sports Medicine. 2009;39(6):439-68.67.Felson DT, Zhang Y, Hannan MT, Anderson JJ. Effects of weight and body mass index on bone mineral density in men and women: the Framingham study. Journal of Bone and Mineral Research. 1993;8(5):567-73.68.Edelstein SL, Barrett-Connor E. Relation between body size and bone mineral density in elderly men and women. American journal of epidemiology. 1993;138(3):160-9.69.Atkins JL, Whincup PH, Morris RW, Lennon LT, Papacosta O, Wannamethee SG. Sarcopenic Obesity and Risk of Cardiovascular Disease and Mortality: A Population‐Based Cohort Study of Older Men. Journal of the American Geriatrics Society. 2014;62(2):253-60.70.Ma J, Hwang S-J, McMahon GM, Curhan GC, McLean RR, Murabito JM, et al. Abstract P252: Sarcopenic Obesity is Associated With a High Burden of Cardiovascular Disease. Circulation. 2015;131(Suppl 1):AP252-AP.71.Montano‐Loza AJ, Angulo P, Meza‐Junco J, Prado CM, Sawyer MB, Beaumont C, et al. Sarcopenic obesity and myosteatosis are associated with higher mortality in patients with cirrhosis. Journal of Cachexia, Sarcopenia and Muscle. 2015.72.Australian Bureau of Statistics. Overweight/Obese: ABS; 2013 [cited 2015 15/4/2015]. Available from: S, Busetto L, Noale M, Limongi F, Crepaldi G. Obesity: Definition and Epidemiology. Multidisciplinary Approach to Obesity: Springer; 2015. p. 31-9.74.WHO. Obesity and Overweight World Health Organisation Media Centre2015 [updated January 2015; cited 2015 13/04/2015]. Available from: JC, Flegal KM. Assessing obesity: classification and epidemiology. British medical bulletin. 1997;53(2):238-52.76.Leonard C, Roza M, Barr R, Webber C. Reproducibility of DXA measurements of bone mineral density and body composition in children. Pediatr Radiol. 2009;39(2):148-54.77.Zoico E, Di Francesco V, Guralnik J, Mazzali G, Bortolani A, Guariento S, et al. Physical disability and muscular strength in relation to obesity and different body composition indexes in a sample of healthy elderly women. International journal of obesity. 2004;28(2):234-41.78.Davison KK, Ford ES, Cogswell ME, Dietz WH. Percentage of body fat and body mass index are associated with mobility limitations in people aged 70 and older from NHANES III. Journal of the American Geriatrics Society. 2002;50(11):1802-9.79.Baumgartner RN, Wayne SJ, Waters DL, Janssen I, Gallagher D, Morley JE. Sarcopenic obesity predicts instrumental activities of daily living disability in the elderly. Obesity research. 2004;12(12):1995-2004.80.Baumgartner RN, Koehler KM, Gallagher D, Romero L, Heymsfield SB, Ross RR, et al. Epidemiology of sarcopenia among the elderly in New Mexico. American journal of epidemiology. 1998;147(8):755-63.81.Dufour AB, Hannan MT, Murabito JM, Kiel DP, McLean RR. Sarcopenia definitions considering body size and fat mass are associated with mobility limitations: the Framingham Study. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2012:gls109.82.Evans E, Rowe D, Racette S, Ross K, McAuley E. Is the current BMI obesity classification appropriate for black and white postmenopausal women? International Journal of Obesity. 2006;30(5):837-43.83.Rahman M, Berenson AB. Accuracy of current body mass index obesity classification for white, black and Hispanic reproductive-age women. Obstetrics and gynecology. 2010;115(5):982.84.Kêkê L, Samouda H, Jacobs J, di Pompeo C, Lemdani M, Hubert H, et al. Body mass index and childhood obesity classification systems: A comparison of the French, International Obesity Task Force (IOTF) and World Health Organization (WHO) references. Revue d'epidemiologie et de sante publique. 2015.85.Carter DR, Beaupré GS. Skeletal function and form: mechanobiology of skeletal development, aging, and regeneration: Cambridge University Press; 2007.86.Rodan GA. The development and function of the skeleton and bone metastases. Cancer. 2003;97(S3):726-32.87.Buckwalter J, Cooper R. Bone structure and function. Instructional course lectures. 1986;36:27-48.88.Cullinane D. The role of osteocytes in bone regulation: mineral homeostasis versus mechanoreception. Journal of Musculoskeletal and Neuronal Interactions. 2002;2(3):242-4.89.Erlebacher A, Derynck R. Increased expression of TGF-beta 2 in osteoblasts results in an osteoporosis-like phenotype. The Journal of cell biology. 1996;132(1):195-210.90.The McGraw-Hill Companies. Bone Structure 2011 [cited 2015 29/10/2015]. Bone Micro-structure]. Available from: . Cell Types in Bones: Boundless; 2015 [updated 21/7/2015; cited 2015 29/10/2015]. Cell Types in Bones]. Available from: KE, Zmuda JM, Strotmeyer ES, Horwitz MJ, Boudreau R, Evans RW, et al. Correlates of trabecular and cortical volumetric bone mineral density of the radius and tibia in older men: the Osteoporotic Fractures in Men Study. Journal of Bone and Mineral Research. 2010;25(5):1017-28.93.Mather J, MacDermid JC, Faber KJ, Athwal GS. Proximal humerus cortical bone thickness correlates with bone mineral density and can clinically rule out osteoporosis. Journal of Shoulder and Elbow Surgery. 2013;22(6):732-8.94.Meema H, MEEMA S. CORTICAL BONE MINERAL DENSITY VERSUS CORTICAL THICKNESS IN THE DIAGNOSIS OF OSTEOPOROSIS: A ROENTGENOLOGIC‐DENSITOMETRIC STUDY*. Journal of the American Geriatrics Society. 1969;17(2):120-41.95.Majumdar S, Genant H, Grampp S, Newitt D, Truong VH, Lin J, et al. Correlation of trabecular bone structure with age, bone mineral density, and osteoporotic status: in vivo studies in the distal radius using high resolution magnetic resonance imaging. Journal of Bone and Mineral Research. 1997;12(1):111-8.96.Lorentzon M, Mellstrom D, Haug E, Ohlsson C. Smoking is associated with lower bone mineral density and reduced cortical thickness in young men. The Journal of clinical endocrinology & metabolism. 2007;92(2):497-503.97.Gnudi S, Sitta E, Fiumi N. Bone density and geometry in assessing hip fracture risk in post-menopausal women. The British journal of radiology. 2014.98.Heinonen A, Oja P, Kannus P, Siev?nen H, M?ntt?ri A, Vuori I. Bone mineral density of female athletes in different sports. Bone and mineral. 1993;23(1):1-14.99.Taaffe DR, Snow‐Harter C, Connolly DA, Robinson TL, Brown MD, Marcus R. Differential effects of swimming versus weight‐bearing activity on bone mineral status of eumenorrheic athletes. Journal of Bone and Mineral Research. 1995;10(4):586-93.100.Brahm H, Str?m H, Piehl-Aulin K, Mallmin H, Ljunghall S. Bone metabolism in endurance trained athletes: a comparison to population-based controls based on DXA, SXA, quantitative ultrasound, and biochemical markers. Calcified tissue international. 1997;61(6):448-54.101.Chien M, Wu Y, Hsu A-T, Yang R, Lai J. Efficacy of a 24-week aerobic exercise program for osteopenic postmenopausal women. Calcified Tissue International. 2000;67(6):443-8.102.Bouxsein ML, Marcus R. Overview of exercise and bone mass. Rheumatic diseases clinics of North America. 1994;20(3):787-802.103.Lee I-M, Sesso HD, Chen J-J, Paffenbarger Jr RS. Does physical activity play a role in the prevention of prostate cancer? Epidemiologic reviews. 2014;23(1):132-7.104.DeLany JP, Kelley DE, Hames KC, Jakicic JM, Goodpaster BH. Effect of physical activity on weight loss, energy expenditure, and energy intake during diet induced weight loss. Obesity. 2014;22(2):363-70.105.Maddocks M, Shrikrishna D, Vitoriano S, Natanek SA, Tanner RJ, Hart N, et al. Skeletal muscle adiposity is associated with physical activity, exercise capacity and fibre shift in COPD. European Respiratory Journal. 2014;44(5):1188-98.106.Addison O, Marcus RL, LaStayo PC, Ryan AS. Intermuscular fat: a review of the consequences and causes. International journal of endocrinology. 2014;2014.107.Therkelsen KE, Pedley A, Hoffman U, Fox C, Murabito J. Abstract MP77: Intramuscular Fat is Associated with Decreased Physical Performance. Circulation. 2015;131(Suppl 1):AMP77-AMP.108.Liu CK, Leng X, Hsu F-C, Kritchevsky S, Ding J, Earnest C, et al. The impact of sarcopenia on a physical activity intervention: the Lifestyle Interventions and Independence for Elders Pilot Study (LIFE-P). The journal of nutrition, health & aging. 2014;18(1):59-64.109.Cvecka J, Tirpakova V, Sedliak M, Kern H, Mayr W, Hamar D. Physical activity in elderly. European Journal of Translational Myology. 2015;25(4):249-52.110.Wang M, Bachrach L, Van Loan M, Hudes M, Flegal K, Crawford P. The relative contributions of lean tissue mass and fat mass to bone density in young women. Bone. 2005;37(4):474-81.111.Lima RM, Bezerra LM, Rabelo HT, Silva MA, Silva AJ, Bottaro M, et al. Fat-free mass, strength, and sarcopenia are related to bone mineral density in older women. Journal of Clinical Densitometry. 2009;12(1):35-41.112.Walsh MC, Hunter GR, Livingstone MB. Sarcopenia in premenopausal and postmenopausal women with osteopenia, osteoporosis and normal bone mineral density. Osteoporosis International. 2006;17(1):61-7.113.Mazess RB, Barden HS, Bisek JP, Hanson J. Dual-energy x-ray absorptiometry for total-body and regional bone-mineral and soft-tissue composition. The American journal of clinical nutrition. 1990;51(6):1106-12.114.Bevier WC, Wiswell RA, Pyka G, Kozak KC, Newhall KM, Marcus R. Relationship of body composition, muscle strength, and aerobic capacity to bone mineral density in older men and women. Journal of bone and mineral research. 1989;4(3):421-32.115.Snow‐Harter C, Bouxsein M, Lewis B, Charette S, Weinstein P, Marcus R. Muscle strength as a predictor of bone mineral density in young women. Journal of Bone and Mineral Research. 1990;5(6):589-95.116.Pasco JA, Holloway KL, Brennan-Olsen SL, Moloney DJ, Kotowicz MA. Muscle strength and areal bone mineral density at the hip in women: a cross-sectional study. BMC musculoskeletal disorders. 2015;16(1):124.117.Ahima RS, Flier JS. Adipose tissue as an endocrine organ. Trends in Endocrinology & Metabolism. 2000;11(8):327-32.118.Kershaw EE, Flier JS. Adipose tissue as an endocrine organ. The Journal of Clinical Endocrinology & Metabolism. 2004;89(6):2548-56.119.Ailhaud G. Adipose tissue as an endocrine organ. International journal of obesity and related metabolic disorders: journal of the International Association for the Study of Obesity. 2000;24:S1-3.120.Galic S, Oakhill JS, Steinberg GR. Adipose tissue as an endocrine organ. Molecular and cellular endocrinology. 2010;316(2):129-39.121.Mohamed-Ali V, Pinkney J, Coppack S. Adipose tissue as an endocrine and paracrine organ. International journal of obesity. 1998;22:1145-58.122.Prins JB. Adipose tissue as an endocrine organ. Best Practice & Research Clinical Endocrinology & Metabolism. 2002;16(4):639-51.123.Jang C, Inder WJ, Obeyesekere VR, Alford FP. Adiponectin, skeletal muscle adiponectin receptor expression and insulin resistance following dexamethasone. Clinical endocrinology. 2008;69(5):745-50.124.Ingelsson E, Arnlov J, Zethelius B, Vasan RS, Flyvbjerg A, Frystyk J, et al. Associations of serum adiponectin with skeletal muscle morphology and insulin sensitivity. The Journal of Clinical Endocrinology & Metabolism. 2009;94(3):953-7.125.Shinoda Y, Yamaguchi M, Ogata N, Akune T, Kubota N, Yamauchi T, et al. Regulation of bone formation by adiponectin through autocrine/paracrine and endocrine pathways. Journal of cellular biochemistry. 2006;99(1):196-208.126.Amemiya N, Otsubo S, Iwasa Y, Onuki T, Nitta K. Association between high-molecular-weight adiponectin and bone mineral density in hemodialysis patients. Clinical and experimental nephrology. 2013;17(3):411-5.127.DiaSorin. LIAISON 25 OH Vitamin D TOTAL Assay 2013:1-9.128.Siemens. Glucose Hexokinase_3 (GLUH_3). 2012.129.Siemens. Triglycerides. 2011.130.Siemens. Wide Range C-Reactive Protein. 2011.131.González‐Gay MA, Llorca J, González‐Juanatey C, Dessein PH. Is the homeostatic model assessment of insulin resistance (HOMA‐IR) a poor predictor of cardiovascular disease in rheumatoid arthritis? Arthritis & Rheumatology. 2015.132.Shaban N, Kenno K, Milne K. The effects of a 2 week modified high intensity interval training program on the homeostatic model of insulin resistance (HOMA-IR) in adults with type 2 diabetes. The Journal of sports medicine and physical fitness. 2014;54(2):203-9.133.Shaw K, Srikanth V, Fryer J, Blizzard L, Dwyer T, Venn A. Dual energy X-ray absorptiometry body composition and aging in a population-based older cohort. International journal of obesity. 2007;31(2):279-84.134.WHO Expert Consultation. Waist circumference and waist-hip ratio. 2011.135.Dalton M, Cameron A, Zimmet P, Shaw J, Jolley D, Dunstan D, et al. Waist circumference, waist–hip ratio and body mass index and their correlation with cardiovascular disease risk factors in Australian adults. Journal of internal medicine. 2003;254(6):555-63.136.Visscher T, Seidell J, Molarius A, van der Kuip D, Hofman A, Witteman J. A comparison of body mass index, waist-hip ratio and waist circumference as predictors of all-cause mortality among the elderly: the Rotterdam study. International journal of obesity and related metabolic disorders: journal of the International Association for the Study of Obesity. 2001;25(11):1730-5.137.Wei M, Gaskill SP, Haffner SM, Stern MP. Waist Circumference as the Best Predictor of Noninsulin Dependent Diabetes Mellitus (NIDDM) Compared to Body Mass Index, Waist/hip Ratio and Other Anthropometric Measurements in Mexican Americans—A 7‐Year Prospective Study. Obesity research. 1997;5(1):16-23.138.Nieto-Garcia FJ, Bush TL, Keyl PM. Body mass definitions of obesity: sensitivity and specificity using self-reported weight and height. Epidemiology. 1990:146-52.139.Wolf AM, Hunter DJ, Colditz GA, Manson JE, Stampfer MJ, Corsano KA, et al. Reproducibility and validity of a self-administered physical activity questionnaire. International journal of epidemiology. 1994;23(5):991-9.140.Dominick KL, Ahern FM, Gold CH, Heller DA. Relationship of health-related quality of life to health care utilization and mortality among older adults. Aging clinical and experimental research. 2002;14(6):499-508.141.Brown WJ, Burton NW, Marshall AL, Miller YD. Reliability and validity of a modified self‐administered version of the Active Australia physical activity survey in a sample of mid‐age women. Australian and New Zealand journal of public health. 2008;32(6):535-41.142.Cargill J, Lucas RM, Gies P, King K, Swaminathan A, Allen MW, et al. Validation of brief questionnaire measures of sun exposure and skin pigmentation against detailed and objective measures including vitamin D status. Photochemistry and photobiology. 2013;89(1):219-26.143.Slater CH, Bick D. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation. JAMA. 1994;271(17):1377-.144.Osborne RH, Hawthorne G, Lew EA, Gray LC. Quality of life assessment in the community-dwelling elderly: validation of the Assessment of Quality of Life (AQoL) Instrument and comparison with the SF-36. Journal of clinical epidemiology. 2003;56(2):138-47.145.Howland J, Lachman ME, Peterson EW, Cote J, Kasten L, Jette A. Covariates of fear of falling and associated activity curtailment. The Gerontologist. 1998;38(5):549-55.146.Tinetti ME, De Leon CFM, Doucette JT, Baker DI. Fear of falling and fall-related efficacy in relationship to functioning among community-living elders. Journal of gerontology. 1994;49(3):M140-M7.147.Hill KD, Schwarz JA, Kalogeropoulos AJ, Gibson SJ. Fear of falling revisited. Archives of physical medicine and rehabilitation. 1996;77(10):1025-9.148.Kempen GI, Todd CJ, Van Haastregt JC, Rixt Zijlstra G, Beyer N, Freiberger E, et al. Cross-cultural validation of the Falls Efficacy Scale International (FES-I) in older people: results from Germany, the Netherlands and the UK were satisfactory. Disability & Rehabilitation. 2007;29(2):155-62.149.WHO. WHO Scientific Group on the Assessment of Osteoporosis at Primary Health Care Level. Belgium, Brussels: 2004 5-7/5/2004. Report No.150.Blake GM, Fogelman I. The role of DXA bone density scans in the diagnosis and treatment of osteoporosis. Postgraduate medical journal. 2007;83(982):509-17.151.Li N, Li X-m, Xu L, Sun W-j, Cheng X-g, Tian W. Comparison of QCT and DXA: osteoporosis detection rates in postmenopausal women. International journal of endocrinology. 2013;2013.152.Dowthwaite JN, Flowers PP, Scerpella TA. Agreement between pQCT‐and DXA‐derived indices of bone geometry, density, and theoretical strength in females of varying age, maturity, and physical activity. Journal of Bone and Mineral Research. 2011;26(6):1349-57.153.Muller A, Ruegsegger E, Ruegsegger P. Peripheral QCT: a low-risk procedure to identify women predisposed to osteoporosis. Physics in medicine and biology. 1989;34(6):741.154.Kontulainen S, Johnston J, Liu D, Leung C, Oxland T, McKay H. Strength indices from pQCT imaging predict up to 85% of variance in bone failure properties at tibial epiphysis and diaphysis. J Musculoskelet Neuronal Interact. 2008;8(4):401-9.155.Tournis S, Antoniou JD, Liakou CG, Christodoulou J, Papakitsou E, Galanos A, et al. Volumetric bone mineral density and bone geometry assessed by peripheral quantitative computed tomography in women with differentiated thyroid cancer under TSH suppression. Clinical endocrinology. 2015;82(2):197-204.156.New World Encyclopaedia. Computed Tomography: New World Encyclopaedia,; 2013 [updated 11/06/2013; cited 2015 26/05/2015]. Available from: TM, Clark BC, Nalls MA, Goodpaster BH, Ploutz-Snyder LL, Harris TB. Reduced physical activity increases intermuscular adipose tissue in healthy young adults. The American journal of clinical nutrition. 2007;85(2):377-84.158.Roberts HC, Denison HJ, Martin HJ, Patel HP, Syddall H, Cooper C, et al. A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age and ageing. 2011:afr051.159.Lang IA, Llewellyn DJ, Alexander K, Melzer D. Obesity, physical function, and mortality in older adults. Journal of the American Geriatrics Society. 2008;56(8):1474-8.160.Rogers ME, Rogers NL, Takeshima N, Islam MM. Methods to assess and improve the physical parameters associated with fall risk in older adults. Preventive medicine. 2003;36(3):255-64.161.Ostir GV, Kuo Y-F, Berges IM, Markides KS, Ottenbacher KJ. Measures of lower body function and risk of mortality over 7 years of follow-up. American journal of epidemiology. 2007;166(5):599-605.162.CDC. The 4-Stage Balance Test2015 13/04/2015. Available from: RA, Bryant AL, Pua Y, McCrory P, Bennell K, Hunt M. Validity and reliability of the Nintendo Wii Balance Board for assessment of standing balance. Gait & posture. 2010;31(3):307-10.164.Batsis JA, Mackenzie TA, Lopez-Jimenez F, Bartels SJ. Sarcopenia, Sarcopenic Obesity and Functional Impairments in Older Adults: NHANES 1999-2004. Nutrition Research. 2015.165.Fielding RA, Vellas B, Evans WJ, Bhasin S, Morley JE, Newman AB, et al. Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International working group on sarcopenia. Journal of the American Medical Directors Association. 2011;12(4):249-56.166.Chumlea WC, Cesari M, Evans W, Ferrucci L, Fielding R, Pahor M, et al. International working group on Sarcopenia. The journal of nutrition, health & aging. 2011;15(6):450-5.167.Auyeung TW, Lee SWJ, Leung J, Kwok T, Woo J. Age‐associated decline of muscle mass, grip strength and gait speed: A 4‐year longitudinal study of 3018 community‐dwelling older Chinese. Geriatrics & gerontology international. 2014;14(S1):76-84.168.Hasegawa Y, Schneider P, Reiners C. Age, sex, and grip strength determine architectural bone parameters assessed by peripheral quantitative computed tomography (pQCT) at the human radius. Journal of biomechanics. 2001;34(4):497-503.169.Szulc P, Blaizot S, Boutroy S, Vilayphiou N, Boonen S, Chapurlat R. Impaired bone microarchitecture at the distal radius in older men with low muscle mass and grip strength: the STRAMBO study. Journal of Bone and Mineral Research. 2013;28(1):169-78.170.Frost HM. The Utah paradigm of skeletal physiology: an overview of its insights for bone, cartilage and collagenous tissue organs. Journal of bone and mineral metabolism. 2000;18(6):305-16.171.Frost H. The Utah Paradigm of Skeletal Physiology Vol. 1. ISMNI [1]. 1960.172.Dodds RA, Connor JR, James IE, Lee Rykaczewski E, Appelbaum E, Dul E, et al. Human osteoclasts, not osteoblasts, deposit osteopontin onto resorption surfaces: an in vitro and ex vivo study of remodeling bone. Journal of Bone and Mineral Research. 1995;10(11):1666-80.173.Jerez S, Chen B. Stability analysis of a Komarova type model for the interactions of osteoblast and osteoclast cells during bone remodeling. Mathematical biosciences. 2015;264:29-37.174.Grimston SK, Willows ND, Hanley DA. Mechanical loading regime and its relationship to bone mineral density in children. Medicine and science in sports and exercise. 1993;25(11):1203-10.175.Holick MF. Perspective on the impact of weightlessness on calcium and bone metabolism. Bone. 1998;22(5):105S-11S.176.Kaji H, Kosaka R, YAMAUCHI M, KUNO K, CHIHARA K, SUGIMOTO T. Effects of age, grip strength and smoking on forearm volumetric bone mineral density and bone geometry by peripheral quantitative computed tomography: comparisons between female and male. Endocrine journal. 2005;52(6):659-66.177.Bousson Va, Le Le Bras A, Roqueplan F, Kang Y, Mitton D, Kolta S, et al. Volumetric quantitative computed tomography of the proximal femur: relationships linking geometric and densitometric variables to bone strength. Role for compact bone. Osteoporosis international. 2006;17(6):855-64.178.Kelsey JL, Browner WS, Seeley DG, Nevitt MC, Cummings SR. Risk factors for fractures of the distal forearm and proximal humerus. American Journal of Epidemiology. 1992;135(5):477-89.179.Leslie WD, Orwoll ES, Nielson CM, Morin SN, Majumdar SR, Johansson H, et al. Estimated lean mass and fat mass differentially affect femoral bone density and strength index but are not FRAX independent risk factors for fracture. Journal of Bone and Mineral Research. 2014;29(11):2511-9.180.Seeman E. Pathogenesis of bone fragility in women and men. The Lancet. 2002;359(9320):1841-50.181.Frost HM, Sch?nau E. The" muscle-bone unit" in children and adolescents: a 2000 overview. Journal of Pediatric Endocrinology and Metabolism. 2000;13(6):571-90.182.Reid IR. Relationships among body mass, its components, and bone. BoneKEy-Osteovision. 2002.183.Thomas T. Leptin: a potential mediator for protective effects of fat mass on bone tissue. Joint Bone Spine. 2003;70(1):18-21.184.Short K, Nair K. Mechanisms of sarcopenia of aging. Journal of endocrinological investigation. 1998;22(5 Suppl):95-105.185.Young N, Formica C, Szmukler G, Seeman E. Bone density at weight-bearing and nonweight-bearing sites in ballet dancers: the effects of exercise, hypogonadism, and body weight. The Journal of Clinical Endocrinology & Metabolism. 1994;78(2):449-54.186.Oshima K, Nampei A, Matsuda M, Iwaki M, Fukuhara A, Hashimoto J, et al. Adiponectin increases bone mass by suppressing osteoclast and activating osteoblast. Biochemical and biophysical research communications. 2005;331(2):520-6.187.Berner HS, Lyngstadaas SP, Spahr A, Monjo M, Thommesen L, Drevon CA, et al. Adiponectin and its receptors are expressed in bone-forming cells. Bone. 2004;35(4):842-9.188.Reid I. Relationships between fat and bone. Osteoporosis International. 2008;19(5):595-606.189.Rosen CJ, Bouxsein ML. Mechanisms of disease: is osteoporosis the obesity of bone? Nature Clinical Practice Rheumatology. 2006;2(1):35-43.190.Meng N, Li C, Liu C, Lin W, Lin C, Chang C, et al. Sarcopenia Defined by Combining Height- and Weight-Adjusted Skeletal Muscle Indices is Closely Associated with Poor Physical Performance. Journal of Aging and Physical Activity. 2015.191.Goodpaster BH, Carlson CL, Visser M, Kelley DE, Scherzinger A, Harris TB, et al. Attenuation of skeletal muscle and strength in the elderly: The Health ABC Study. Journal of Applied Physiology. 2001;90(6):2157-65.AppendicesTable 4. Descriptive statistics for the 2015 cohort, grouped by sexFactorSexP ValueMale (N=9)Female (N=18)Sig.General?mean ± SDmean ± SD?Age (y)64 ± 1063 ± 90.77Height (cm)173 ± 4160 ± 70.00Weight (kg)94.7 ± 12.978.8 ± 17.60.02Blood Biochemistry????Vitamin D (nmol/L)52 ± 2056 ± 160.64Glucose (mmol/L)5.8 ± 0.45.6 ± 1.80.80C-Reactive Protein (mg/L)2.5 ± 2.33.0 ± 3.40.66Cholesterol (mmol/L)4.3 ± 1.05 ± 0.80.09Triglycerides (mmol/L)1.3 ± 0.51.2 ± 0.30.76High-Density Lipoprotein (mmol/L)1.2 ± 0.31.6 ± 0.40.01Low-Density Lipoprotein (mmol/L)2.5 ± 0.72.8 ± 0.70.36Insulin (mIU/L)8.7 ± 3.18.1 ± 7.20.83Physical Performance????Dominant Grip Strength Average (kg)41.0 ± 6.224.8 ± 7.60.00Dominant Leg Knee Extension Average (kg)28.1 ± 6.521.7 ± 5.90.02Average Path Length (cm)51.4 ± 31.243.3 ± 25.40.49Average Path Velocity1.7 ± 1.06.1 ± 18.80.49Average Mediolateral Amplitude (cm)1.2 ± 0.58.6 ± 29.40.46Average Anterioposterior Amplitude3.5 ± 2.036.6 ± 135.10.47Average Mediolateral Path Velocity0.5 ± 0.21.8 ± 5.30.49Average Anterioposterior Path Velocity1.5 ± 1.05.3 ± 16.20.49Average Stair Climb (s)5.0 ± 1.35.4 ± 1.70.61Gait Speed (m/s)0.8 ± 0.10.8 ± 0.20.54Anthropometry????BMI (kg/m2)31.6 ± 4.831.0 ± 7.00.81Total body fat (kg)31.6 ± 5.040.5 ± 6.70.00Bone Density (T-score)0.9 ± 1.8-1.6 ± 1.60.02Subtotal BMD (mg/cm3)1.1 ± 0.20.9 ± 0.10.00Left Arm BMD (mg/cm3)1.0 ± 0.10.7 ± 0.10.00Right Arm BMD (mg/cm3)1.0 ± 0.20.7 ± 0.10.00Left Leg BMD (mg/cm3)1.3 ± 0.41.0 ± 0.20.03Right Leg BMD (mg/cm3)1.3 ± 0.31.0 ± 0.30.04Proximal Tibia Muscle CSA (mm2)8438.0 ± 1149.56808.2 ± 1403.30.01Proximal Tibia Muscle density (mg/cm3)71.9 ± 2.671.4 ± 5.70.80Proximal Tibia IMAT (mm2)442 ± 283.5380 ± 449.30.71Proximal Tibia Cortical Density (mg/cm3)1070.7 ± 29.81042.2 ± 39.30.07Proximal Tibia Cortical Area (mm2)361.3 ± 55.4256.4 ± 47.90.00Proximal Tibia Cortical Thickness (mm)4.4 ± 0.83.4 ± 0.70.00Proximal Radius Muscle CSA (mm2)4375.8 ± 727.22803.9 ± 554.30.00Proximal Radius Muscle density (mg/cm3)73.6 ± 4.975.1 ± 3.50.39Proximal Radius IMAT (mm2)643.7 ± 255.9364.4 ± 146.10.01Proximal Radius Cortical Density (mg/cm3)1071.9 ± 61.81053.1 ± 54.00.42Proximal Radius Cortical Area (mm2)98.7 ± 14.759.3 ± 12.30.00Proximal Radius Cortical Thickness (mm)2.1 ± 0.31.4 ± 0.30.00Appendicular Lean Mass (kg)27.9 ± 3.319.6 ± 3.70.00Arm Fat (kg)3.0 ± 0.84.0 ± 1.80.11Arms Lean Mass (kg)7.4 ± 1.04.5 ± 1.00.00Leg Fat (kg)8.0 ± 3.811.4 ± 4.30.06Legs Lean Mass (kg)20.5 ± 2.515.1 ± 2.80.00Right Leg Fat (kg)4.12 ± 2.05.9 ± 2.30.06Right Leg Lean Mass (kg)10.3 ± 1.27.6 ± 1.50.00Left Leg Lean Mass (kg)10.2 ± 1.37.5 ± 1.40.00Left Leg Fat (kg)3.9 ± 1.85.5 ± 2.00.05Left Arm Lean Mass (kg)3.7 ± 0.52.2 ± 0.50.00Left Arm Fat (kg)1.4 ± 0.42.0 ± 0.90.11Right Arm Lean Mass (kg)3.7 ± 0.52.3 ± 0.50.00Right Arm Fat (kg)1.6 ± 0.42.1 ± .080.12Questionnaire????Bad Health Days2.1 ± 5.06.3 ± 7.50.14Bad Mental Health Days1.9 ± 5.04.2 ± 8.80.48Vegetable Servings Daily2.2 ± 1.62.5 ± 1.30.65Fruit Servings Daily1.7 ± 1.01.8 ± 1.10.69Hours Outdoors Weekday2.7 ± 2.92.1 ± 1.50.51Hours Outdoors Weekend2.6 ± 1.63.1 ± 2.10.50Walking Time (min/week)62.2 ± 42.0121.3 ± 117.80.16Vigorous Activity Time (min/week)26.7 ± 60.1146.1 ± 221.60.04Vigorous Physical Activity Time (min/week)95.0 ± 174.953.2 ± 93.00.41Moderate Physical Activity Time (min/week)151.7 ± 395.248.95 ± 89.60.46Table 5. Descriptive statistics for the entire cohort (n=65) grouped by sexFactorSexMale (N=22)Female (N=43)Sig.General?mean ± SDmean ± SD?Age (y)62 ± 863 ± 80.69Height (cm)172 ± 6160 ± 80.00Weight (kg)97.1 ± 15.185.8 ± 20.80.03Blood Biochemistry????Vitamin D (nmol/L)48.7 ± 20.048.7 ± 16.01.00Glucose (mmol/L)6.4 ± 2.26.4 ± 2.20.93C-Reactive Protein (mg/L)2.7 ± 3.24.6 ± 5.80.17Cholesterol (mmol/L)4.5 ± 1.14.9 ± 1.20.21Triglycerides (mmol/L)1.7 ± 1.01.3 ± 0.50.13High-Density Lipoprotein (mmol/L)1.19 ± 0.271.51 ± 0.370.00Low-Density Lipoprotein (mmol/L)2.55 ± 0.912.78 ± 1.030.37Insulin (mIU/L)9.55 ± 8.7211.28 ± 11.390.53Physical Performance????Dominant Grip Strength Average (kg)39.63 ± 6.924.33 ± 7.80.00Dominant Leg Knee Extension Average (kg)17.2 ± 10.714.5 ± 7.70.30Average Path Length (cm)40.8 ± 22.740.2 ± 16.90.90Average Path Velocity1.4 ± 0.81.3 ± 0.60.90Average Mediolateral Amplitude (cm)1.1 ± 0.41.3 ± 1.00.35Average Anterioposterior Amplitude2.9 ± 1.52.8 ± 1.20.81Average Mediolateral Path Velocity0.5 ± 0.20.5 ± 0.20.95Average Anterioposterior Path Velocity1.2 ± 0.71.2 ± 0.50.87Average Stair Climb (s)5.9 ± 3.96.1 ± 2.10.78Gait Speed (m/s)0.8 ± 0.20.8 ± 0.20.43Anthropometry????BMI (kg/m2)32.8 ± 5.633.3 ± 6.70.76Total body fat (kg)31.2 ± 5.9841.2 ± 6.90.00Bone Density (T-score)-0.2 ± 1.4-1.0 ± 1.80.09Subtotal BMD (g/cm2)1.1 ± 0.20.9 ± 0.20.00Left Arm BMD (g/cm2)0.94 ± 0.10.8 ± 0.20.00Right Arm BMD (g/cm2)1.0 ± 0.20.8 ± 0.20.00Left Leg BMD (g/cm2)1.3 ± 0.31.1 ± 0.20.01Right Leg BMD (g/cm2)1.2 ± 0.21.1 ± 0.30.02Proximal TibiaMuscle CSA (mm2)8613.5 ± 9746908.4 ± 1658.20.00Muscle density (mg/cm3)71.7 ± 3.371.5 ± 4.70.85IMAT (mm2)420.0 ± 270.8368.2 ± 427.50.61Cortical Density (mg/cm3)1056.9 ± 37.51037.5 ± 37.60.05Cortical Area (mm2)348.9 ± 51.0255.5 ± 47.80.00Cortical Thickness (mm)4.1 ± 0.73.3 ± 0.60.00Proximal RadiusMuscle CSA (mm2)4391.9 ± 570.62911.3 ± 705.10.00Muscle density (mg/cm3)73.8 ± 5.273.2 ± 5.10.65IMAT (mm2)625.5 ± 241.3411.6 ± 184.30.00Cortical Density (mg/cm3)1078.8 ± 48.51061.5 ± 58.80.24Cortical Area (mm2)100.5 ± 12.865.1 ± 15.50.00Cortical Thickness (mm)2.2 ± 0.31.6 ± 0.40.00Mass MeasuresAppendicular Lean Mass (kg)28.3 ± 2.720.7 ± 5.60.00Arm Fat (kg)3.2 ± 1.04.5 ± 1.70.00Arms Lean Mass (kg)7.5 ± 0.74.8 ± 1.20.00Leg Fat (kg)8.14 ± 3.711.81 ± 4.30.00Legs Lean Mass (kg)20.8 ± 2.215.9 ± 4.50.00Right Leg Fat (kg)4.2 ± 2.06.1 ± 2.20.00Right Leg Lean Mass (kg)10.5 ± 1.18.0 ± 2.40.00Left Leg Lean Mass (kg)10.3 ± 1.17.9 ± 2.20.00Left Leg Fat (kg)3.9 ± 1.75.8 ± 2.10.00Left Arm Lean Mass (kg)3.7 ± 0.42.3 ± 0.60.00Left Arm Fat (kg)1.5 ± 0.52.2 ± 0.840.00Right Arm Lean Mass (kg)3.8 ± 0.42.5 ± 0.60.00Right Arm Fat (kg)1.7 ± 0.52.3 ± 0.80.00Questionnaire????Bad Health Days2.2 ± 6.04.48 ± 8.10.02Bad Mental Health Days2..5 ± 4.05.2 ± 7.70.43Vegetable Servings Daily2.2 ± 1.32.5 ± 1.20.33Fruit Servings Daily1.6 ± 1.11.8 ± 1.10.57Hours Outdoors Weekday3.1 ± 3.01.8 ± 1.80.04Hours Outdoors Weekend4.1 ± 3.82.7 ± 2.10.12Walking Time (min/week)132.6 ± 135.5166.9 ± 186.50.46Vigorous Activity Time (min/week)101.4 ± 315.984.7 ± 173.40.78Vigorous Physical Activity Time (min/week)104.8 ± 182.843.0 ± 100.80.15Moderate Physical Activity Time (min/week)109.8 ± 260.336.8 ± 1000.22Table 6. Descriptive statistics comparison 2013/14 cohort against 2015 cohort?FactorCohortNmean ± SDP ValueGeneralAge (y)20143962.56±6.740.5620152663.74±9.63Height (cm)201439164.25±9.370.99201526164.22±9.04Weight (kg)20143993.03±20.490.1120152685.00±17.82Blood BiochemistryVitamin D (nmol/L)20143944.69±16.430.0320152654.42±17.43Glucose (mmol/L)2014386.91±2.470.032015265.72±1.53C-Reactive Protein (mg/L)2014394.64±6.030.152015262.96±3.10Cholesterol (mmol/L)2014394.78±1.350.852015264.72±0.91Triglycerides (mmol/L)2014391.62±0.860.052015261.25±0.45High-Density Lipoprotein (mmol/L)2014391.34±0.330.152015261.47±0.39Low-Density Lipoprotein (mmol/L)2014382.71±1.170.902015262.67±0.69Physical PerformanceHand Grip Strength (kg)20143929.18±10.390.6820152630.27±10.49Leg Extension Strength (kg)2014399.88±5.210.0020152623.69±6.37Stair Climb Time (s)2014396.55±3.330.082015265.30±1.55Timed Mean gait speed (m/s)2014390.77±0.190.332015260.81±0.16AnthropometryBone Density (T-score)201439-0.53±1.580.27201526-1.01±1.87Subtotal BMD (mg/cm3)2014390.98±0.140.782015260.97±0.20Left Arm BMD(mg/cm3)2014390.83±0.160.532015260.80±0.18Right Arm BMD (mg/cm3)2014390.86±0.160.742015260.84±0.19Left Leg BMD (mg/cm3)2014391.13±0.210.842015261.14±0.33Right Leg BMD (mg/cm3)2014391.14±0.210.822015261.15±0.30Proximal TibiaMuscle CSA (mm2)2014397543.97±1675.820.722015267397.83±1529.39Muscle density (mg/cm3)20143971.65±3.880.8520152671.45±4.84IMAT (mm2)201439368.14±370.680.65201526412.12±400.25Cortical Density (mg/cm3)2014391039.52±38.010.252015261050.76±38.79Cortical Area (mm2)201439284.41±62.180.69201526291.12±72.00Cortical Thickness (mm)2014393.46±0.670.242015263.69±0.88Proximal RadiusMuscle CSA (mm2)2014393450.70±963.540.822015243391.90±995.19Muscle density (mg/cm3)20143972.72±5.540.1720152474.56±4.08IMAT (mm2)201439493.41±229.100.76201524474.67±231.82Cortical Density (mg/cm3)2014391072.58±54.780.362015261059.41±57.32Cortical Area (mm2)20143979.72±21.600.2420152673.05±23.13Cortical Thickness (mm)2014391.93±0.470.012015261.62±0.47Mass MeasuresAppendicular Lean Mass (kg)20143923.75±6.390.4220152622.53±5.35Right Leg Fat (kg)2014395.50±2.270.772015265.33±2.31Right Leg Lean Mass (kg)2014399.01±2.580.462015268.57±1.91Left Leg Lean Mass (kg)2014398.85±2.410.482015268.45±1.84Left Leg Fat (kg)2014395.20±2.200.782015265.04±2.12Left Arm Lean Mass (kg)2014392.87±0.820.452015262.71±0.89Left Arm Fat (kg)2014392.03±0.780.242015261.79±0.83Right Arm Lean Mass (kg)2014393.02±0.840.302015262.80±0.84Right Arm Fat (kg)2014392.20±0.820.202015261.94±0.76QuestionnaireVegetable Servings Daily2014392.41±1.160.972015262.42±1.36Fruit Servings Daily2014391.72±1.070.752015261.81±1.10Hours Outdoors Weekend2014393.30±3.310.712015263.03±1.96Hours Outdoors Weekday2014392.15±2.500.732015262.35±2.05Walking Time201438192.24±199.810.05201526106.92±105.37Vigorous Activity Time20143881.05±249.480.66201526106.73±197.10Vigorous Physical Activity Time20143860.26±144.880.7920152669.81±127.49Moderate Physical Activity Time20143944.54±109.180.3220152688.27±240.31-73982-374015Table 7. Two Way MANOVA between sarcopenic and obese participants00Table 7. Two Way MANOVA between sarcopenic and obese participantsSarcopenic DifferencesSig.Obesity DifferencesSig.Interaction Sig.General???General???General??Age (y).289Age (y).215Age (y).645Height (cm).898Height (cm).158Height (cm).470Weight (kg).021Weight (kg).372Weight (kg).630Blood Biochemistry???Blood Biochemistry???Blood Biochemistry??Vitamin D (nmol/L).975Vitamin D (nmol/L).519Vitamin D (nmol/L).028Glucose (mmol/L).275Glucose (mmol/L).750Glucose (mmol/L).837C-Reactive Protein (mg/L).153C-Reactive Protein (mg/L).133C-Reactive Protein (mg/L).227Cholesterol (mmol/L).085Cholesterol (mmol/L).311Cholesterol (mmol/L).867Triglycerides (mmol/L).094Triglycerides (mmol/L).011Triglycerides (mmol/L).326High-Density Lipoprotein (mmol/L).002High-Density Lipoprotein (mmol/L).111High-Density Lipoprotein (mmol/L).098Low-Density Lipoprotein (mmol/L).174Low-Density Lipoprotein (mmol/L).267Low-Density Lipoprotein (mmol/L).845Physical Performance???Physical Performance???Physical Performance??Hand Grip Strength (kg).460Hand Grip Strength (kg).662Hand Grip Strength (kg).593Leg Extension Strength (kg).719Leg Extension Strength (kg).337Leg Extension Strength (kg).020Gait Speed (m/s).274Gait Speed (m/s).659Gait Speed (m/s).858Stair Climb (s).701Stair Climb (s).825Stair Climb (s).564Anthropometry??????????Bone Density (T-score).952Bone Density (T-score).962Bone Density (T-score).320Subtotal BMD (mg/cm3).492Subtotal BMD (mg/cm3).978Subtotal BMD.564Left Arm BMD (mg/cm3).623Left Arm BMD (mg/cm3).896Left Arm BMD.984Right Arm BMD (mg/cm3).414Right Arm BMD (mg/cm3).806Right Arm BMD.898Left Leg BMD (mg/cm3).430Left Leg BMD (mg/cm3).906Left Leg BMD.478Right Leg BMD (mg/cm3).310Right Leg BMD (mg/cm3).971Right Leg BMD.644Proximal Tibia???Proximal Tibia???Proximal Tibia??Muscle CSA (mm2).006Muscle CSA (mm2).684Muscle CSA (mm2).619Muscle density (mg/cm3).280Muscle density (mg/cm3).460Muscle density (mg/cm3).958Tibia IMAT (mm2).058Tibia IMAT (mm2).928Tibia IMAT (mm2).533Cortical Density (mg/cm3).872Cortical Density (mg/cm3).947Cortical Density (mg/cm3).494Cortical Area (mm2).446Cortical Area (mm2).370Cortical Area (mm2).934Cortical Thickness (mm).512Cortical Thickness (mm).569Cortical Thickness (mm).909Proximal Radius???Proximal Radius???Proximal Radius??Muscle CSA (mm2).093Muscle CSA (mm2).828Muscle CSA (mm2).613Muscle density (mg/cm3).107Muscle density (mg/cm3).614Muscle density (mg/cm3).458Tibia IMAT (mm2).027Tibia IMAT (mm2).897Tibia IMAT (mm2).995Cortical Density (mg/cm3).298Cortical Density (mg/cm3).760Cortical Density (mg/cm3).559Cortical Area (mm2).846Cortical Area (mm2).667Cortical Area (mm2).733Cortical Thickness (mm).600Cortical Thickness (mm).759Cortical Thickness (mm).891Mass Measures???Mass Measures???Mass Measures??Appendicular Lean Mass (kg).028Appendicular Lean Mass (kg).472Appendicular Lean Mass (kg).867Right Leg Fat (kg).774Right Leg Fat (kg).269Right Leg Fat (kg).015Right Leg Lean Mass (kg).024Right Leg Lean Mass (kg).430Right Leg Lean Mass (kg).829Left Leg Lean Mass (kg).040Left Leg Lean Mass (kg).429Left Leg Lean Mass (kg).913Left Leg Fat (kg).756Left Leg Fat (kg).206Left Leg Fat (kg).019Left Arm Lean Mass (kg).071Left Arm Lean Mass (kg).779Left Arm Lean Mass (kg).646Left Arm Fat (kg).076Left Arm Fat (kg).012Left Arm Fat (kg).170Right Arm Lean Mass (kg).030Right Arm Lean Mass (kg).567Right Arm Lean Mass (kg).678Right Arm Fat (kg).132Right Arm Fat (kg).003Right Arm Fat (kg).050Bad Health Days.242Bad Health Days.966Bad Health Days.311Bad Mental Health Days.156Bad Mental Health Days.756Bad Mental Health Days.463Hours Outdoors Weekday.256Hours Outdoors Weekday.209Hours Outdoors Weekday.724Hours Outdoors Weekend.253Hours Outdoors Weekend.997Hours Outdoors Weekend.167Vegetable Servings Daily.248Vegetable Servings Daily.763Vegetable Servings Daily.875Fruit Servings Daily.033Fruit Servings Daily.001Fruit Servings Daily.024Walking Time.034Walking Time.157Walking Time.433Vigorous Actvity Time.878Vigorous Actvity Time.266Vigorous Actvity Time.422Vigorous Physical Acitvity Time.867Vigorous Physical Acitvity Time.666Vigorous Physical Acitvity Time.204Moderate Physical Activity Time.120Moderate Physical Activity Time.124Moderate Physical Activity Time.043Table 8. Bivariate Analysis Bone parameters???????????Proximal TibiaProximal RadiusHand Grip Strength (kg)Leg Extension Strength (kg)Bone Density (T-score)Subtotal BMD (g/cm2)Left Arm BMD (g/cm2)Right Arm BMD (g/cm2)Left Leg BMD (g/cm2)Right Leg BMD (g/cm2) Cortical Density (mg/cm3)Cortical Area (mm2)Cortical Thickness (mm)Cortical Density (mg/cm3)Cortical Area (mm2)Cortical Thickness (mm)GeneralN≥63???????????????Age (y)r-.174.019-.033.021.061.070.043.032-.270-.092-.207-.429-.048-.204p.162.877.790.869.628.578.734.798.030.465.098.000.707.103Height (cm)r.711.261.304.488.615.547.334.278.256.751.561.128.707.493p.000.035.013.000.000.000.007.025.039.000.000.308.000.000Weight (kg)r.410-.077.459.556.606.495.417.365.191.482.321-.069.443.179p.001.540.000.000.000.000.001.003.128.000.009.585.000.155Blood Biochemistry???????????????Vitamin D (nmol/L)r.085.343-.171-.108-.005-.043-.178-.132.023.054.010-.079.062-.125p.496.005.171.393.968.732.155.293.857.670.935.533.625.322Glucose (mmol/L)r-.096-.267.176.140.073.105.094.108-.007.013-.020-.243.023-.068p.448.031.161.270.568.411.459.396.956.919.875.053.859.592C-Reactive Protein (mg/L)r-.063-.210.094.073.063.024.078.035-.067-.177-.148.009-.155-.147p.617.090.452.563.620.847.539.781.595.158.239.945.216.244Cholesterol (mmol/L)r-.115-.068-.090-.154-.100-.156-.105-.140-.106-.206-.170.263-.156-.025p.359.587.471.220.426.214.403.265.403.099.176.034.215.843Triglycerides (mmol/L)r.072-.322.056.059-.010.001.034.033-.032-.010-.014.005.148.215p.566.008.654.642.940.994.788.795.803.937.912.967.239.086High-Density Lipoprotein (mmol/L)r-.341.105-.246-.365-.297-.235-.293-.283-.190-.404-.299.083-.404-.266p.005.400.046.003.016.060.018.023.130.001.016.512.001.032Low-Density Lipoprotein (mmol/L)r-.035-.011-.032-.072-.006-.102-.034-.080-.048-.101-.093.279-.090-.001p.780.932.799.574.960.424.792.531.708.425.467.026.481.993Insulin (mIU/L)r-.164-.196.139.064-.073.030-.032.124.099-.037.020-.164-.098-.169p.191.118.271.617.568.816.800.330.438.769.875.194.442.182Physical Performance???????????????Hand Grip Strength (kg)r1.347.235.469.603.485.341.306.231.697.564.143.714.486p.004.058.000.000.000.005.013.064.000.000.257.000.000Leg Extension Strength (kg)r.3471-.018.118.156.160.100.126.158.248.264-.098.111-.132p.004.888.349.214.204.430.319.209.046.033.436.380.294Average Stair Climb (s)r-.108-.322.094.077.016.091.038-.005-.040-.083-.169-.235.004-.207p.388.008.452.543.898.471.762.970.754.512.179.059.975.098Gait Speed (m/s)r-.108-.322.094.077.016.091.038-.005-.040-.083-.169-.235.004-.207p.388.008.452.543.898.471.762.970.754.512.179.059.975.098Anthropometry????????????????BMI (kg/m2)r.058-.228.351.352.334.243.275.263.108.128.068-.137.097-.074p.642.066.004.004.007.051.026.034.392.308.589.276.441.561Total body fat (kg)r-.525-.177-.035-.217-.273-.220-.130-.114-.012-.521-.366-.003-.615-.477p.000.157.780.083.028.078.302.365.925.000.003.981.000.000Bone Density (T-score)r.235-.0181.903.551.534.826.839.403.541.521.198.447.355p.058.888.000.000.000.000.000.001.000.000.114.000.004Subtotal BMD (g/cm2)r.469.118.9031.711.684.911.897.385.709.624.077.638.416p.000.349.000.000.000.000.000.002.000.000.544.000.001Left Arm BMD (g/cm2)r.603.156.551.7111.714.496.443.323.688.532.122.763.543p.000.214.000.000.000.000.000.009.000.000.334.000.000Right Arm BMD (g/cm2)r.485.160.534.684.7141.498.410.314.615.499.004.613.310p.000.204.000.000.000.000.001.011.000.000.974.000.012Left Leg BMD (g/cm2)r.341.100.826.911.496.4981.924.281.566.513.070.443.288p.005.430.000.000.000.000.000.023.000.000.580.000.020Right Leg BMD (g/cm2)r.306.126.839.897.443.410.9241.334.551.533.057.399.265p.013.319.000.000.000.001.000.006.000.000.652.001.033Proximal Tibia????????????????Muscle CSA (mm2)r.616.068.349.528.671.561.375.336.206.709.534-.033.674.398p.000.590.004.000.000.000.002.006.100.000.000.797.000.001Tibia Muscle density (mg/cm3)r-.001.098-.106-.217-.279-.327-.171-.102.171-.108.031.335-.094.149p.994.436.401.082.024.008.173.418.173.390.806.006.455.235IMAT (mm2)r.203.015.271.389.444.436.323.265-.032.335.206-.196.290.053p.105.904.029.001.000.000.009.033.797.006.100.117.019.673Cortical Density (mg/cm3)r.231.158.403.385.323.314.281.3341.545.737.409.302.289p.064.209.001.002.009.011.023.006.000.000.001.014.020Cortical Area (mm2)r.697.248.541.709.688.615.566.551.5451.909.197.808.574p.000.046.000.000.000.000.000.000.000.000.116.000.000Cortical Thickness (mm)r.564.264.521.624.532.499.513.533.737.9091.307.635.514p.000.033.000.000.000.000.000.000.000.000.013.000.000Proximal Radius????????????????Muscle CSA (mm2)r.758.198.327.603.681.595.475.462.153.708.511-.049.857.567p.000.120.009.000.000.000.000.000.230.000.000.703.000.000Muscle density (mg/cm3)r-.014.156-.138-.167-.133-.286-.169-.101-.136-.006-.022.293-.011.232p.911.224.282.192.299.023.187.429.288.962.863.020.933.067IMAT (mm2)r.555.125.332.567.623.674.460.409.166.518.365-.308.604.123p.000.330.008.000.000.000.000.001.193.000.003.014.000.337Cortical Density (mg/cm3)r.143-.098.198.077.122.004.070.057.409.197.3071.227.616p.257.436.114.544.334.974.580.652.001.116.013.069.000Cortical Area (mm2)r.714.111.447.638.763.613.443.399.302.808.635.2271.780p.000.380.000.000.000.000.000.001.014.000.000.069.000Cortical Thickness (mm)r.486-.132.355.416.543.310.288.265.289.574.514.616.7801p.000.294.004.001.000.012.020.033.020.000.000.000.000Mass Measures????????????????Appendicular Lean Mass (kg)r.677.065.416.613.673.576.457.403.229.761.542.000.732.436p.000.605.001.000.000.000.000.001.067.000.0001.000.000.000Arm Fat (kg)r-.333-.219.274.095-.044.011.077.134.191-.197-.098-.023-.365-.333p.007.080.027.452.731.933.543.286.128.115.438.857.003.007Arms Lean Mass (kg)r.734.139.380.603.707.626.407.381.260.804.594.021.853.557p.000.270.002.000.000.000.001.002.037.000.000.865.000.000Leg Fat (kg)r-.302-.160.129.018-.065-.028.079.052.047-.214-.181.060-.349-.303p.015.204.304.887.607.827.532.681.713.087.149.638.004.014Legs Lean Mass (kg)r.626.035.410.588.630.531.455.393.207.710.498-.008.654.371p.000.781.001.000.000.000.000.001.098.000.000.950.000.002Questionnaire????????????????Bad Health Daysr-.168-.085-.118-.220-.260-.270-.147-.173-.060-.127-.081-.086-.208-.245p.178.496.347.079.036.030.242.169.638.314.523.496.096.049Fruit Servings Dailyr.000.012-.198-.176.000-.213-.128-.134.015-.052-.018.055-.038.102p.999.923.110.161.998.089.310.288.907.681.886.666.762.421Hours Outdoors Weekdayr.302.195.056.159.208.192.117.121-.077.207.132.018.216.132p.014.116.657.207.096.125.353.338.541.098.295.887.084.294Hours Outdoors Weekendr.237.021.014.098.081.141.089.104-.177.106.028-.019.132.109p.055.868.912.437.520.264.480.410.158.399.828.881.294.386Table 9. Bivariate Analysis Muscle parameters?????????Proximal TibiaProximal Radius?????Hand Grip Strength (kg)Leg Extension Strength (kg)Average Stair ClimbTimed Mean gait speed (m/s)BMI (kg/m2)Total body fat (kg)Muscle CSA (mm2)Muscle density (mg/cm3)IMAT (mm2)Muscle CSA (mm2)Muscle density (mg/cm3)IMAT (mm2)Appendicular Lean Mass (kg)Arm Fat (kg)Arms Lean Mass (kg)Leg Fat (kg)Legs Lean Mass (kg)General???????????????????Age (y)r-.174.019.175-.067-.181-.103-.101-.235-.015-.058-.107.121-.147-.259-.123-.166-.148p.162.877.161.591.145.414.424.060.908.649.403.343.244.037.328.185.238Height (cm)r.711.261.049-.063-.034-.656.598-.185.344.674-.077.502.785-.375.795-.314.745p.000.035.697.615.784.000.000.140.005.000.551.000.000.002.000.011.000Weight (kg)r.410-.077.383-.157.854.065.651-.421.595.548-.393.657.812.439.621.432.846p.001.540.001.207.000.608.000.000.000.000.001.000.000.000.000.000.000Blood Biochemistry??????????????????Vitamin D (nmol/L)r.085.343.182-.004-.089-.079.000-.080.001-.023.140.102.048-.177.007.032.060p.496.005.144.975.475.529.999.527.992.855.273.425.707.159.956.798.633Glucose (mmol/L)r-.096-.267.269-.239.294-.102.112-.343.239.119-.404.283.266.139.226-.149.269p.448.031.030.055.018.420.380.006.057.359.001.026.034.272.073.239.031C-Reactive Protein (mg/L)r-.063-.210.252-.124.483.441-.017-.233.169-.108-.340.150.006.475-.111.405.048p.617.090.041.323.000.000.895.062.179.400.006.242.964.000.380.001.702Cholesterol (mmol/L)r-.115-.068.111.021-.073.273-.258.171-.198-.288.111-.227-.255.031-.326.287-.217p.359.587.373.868.559.028.038.173.115.022.387.074.041.805.008.020.083Triglycerides (mmol/L)r.072-.322-.010.076.018-.134.074.133-.017.160.044-.023.065-.036.137-.160.035p.566.008.939.543.885.289.560.291.893.210.735.858.608.773.276.203.781High-Density Lipoprotein (mmol/L)r-.341.105-.034.002-.286.301-.514.130-.307-.501-.010-.307-.553-.030-.581.156-.517p.005.400.788.985.020.015.000.304.013.000.939.014.000.814.000.216.000Low-Density Lipoprotein (mmol/L)r-.035-.011.138-.005.007.266-.152.134-.132-.219.133-.157-.130.057-.225.335-.090p.780.932.273.969.954.034.231.291.299.088.304.223.306.652.074.007.481Insulin (mIU/L)r-.164-.196.186-.148.309.201.015.064.085-.006-.166.069.016.412.041.088.006p.191.118.139.239.012.112.905.615.506.961.198.595.897.001.749.490.963Physical Performance??????????????????Hand Grip Strength (kg)r1.347-.108.002.058-.525.616-.001.203.758-.014.555.677-.333.734-.302.626p.004.388.986.642.000.000.994.105.000.911.000.000.007.000.015.000 Leg Extension Strength (kg)r.3471-.322.167-.228-.177.068.098.015.198.156.125.065-.219.139-.160.035p.004.008.181.066.157.590.436.904.120.224.330.605.080.270.204.781Average Stair Climbr-.108-.3221-.527.372.078.040-.425.223.046-.540.367.218.148.070.209.262p.388.008.000.002.535.752.000.074.718.000.003.082.240.579.095.035Timed Mean gait speed (m/s)r.002.167-.5271-.126.087-.105.185-.068-.160.370-.376-.145.000-.171.110-.129p.986.181.000.315.489.407.140.590.212.003.002.249.999.174.385.307Anthropometry??????????????????BMI (kg/m2)r.058-.228.372-.1261.465.398-.337.448.228-.382.441.460.742.247.682.517p.642.066.002.315.000.001.006.000.072.002.000.000.000.047.000.000Total body fat (kg)r-.525-.177.078.087.4651-.360-.008-.014-.574-.092-.259-.495.814-.621.809-.426p.000.157.535.489.000.003.950.913.000.474.040.000.000.000.000.000Bone Density (T-score)r.235-.018.094.076.351-.035.349-.106.271.327-.138.332.416.274.380.129.410p.058.888.452.542.004.780.004.401.029.009.282.008.001.027.002.304.001Subtotal BMD (g/cm2)r.469.118.077-.016.352-.217.528-.217.389.603-.167.567.613.095.603.018.588p.000.349.543.899.004.083.000.082.001.000.192.000.000.452.000.887.000Left Arm BMD (g/cm2)r.603.156.016-.003.334-.273.671-.279.444.681-.133.623.673-.044.707-.065.630p.000.214.898.984.007.028.000.024.000.000.299.000.000.731.000.607.000Right Arm BMD (g/cm2)r.485.160.091-.048.243-.220.561-.327.436.595-.286.674.576.011.626-.028.531p.000.204.471.705.051.078.000.008.000.000.023.000.000.933.000.827.000Left Leg BMD (g/cm2)r.341.100.038.018.275-.130.375-.171.323.475-.169.460.457.077.407.079.455p.005.430.762.885.026.302.002.173.009.000.187.000.000.543.001.532.000Right Leg BMD (g/cm2)r.306.126-.005.054.263-.114.336-.102.265.462-.101.409.403.134.381.052.393p.013.319.970.671.034.365.006.418.033.000.429.001.001.286.002.681.001Proximal Tibia??????????????????Muscle CSA (mm2)r.616.068.040-.105.398-.3601-.397.682.796-.121.674.807-.031.807-.048.770p.000.590.752.407.001.003.001.000.000.344.000.000.807.000.703.000Muscle density (mg/cm3)r-.001.098-.425.185-.337-.008-.3971-.800-.304.511-.542-.326-.084-.215-.121-.352p.994.436.000.140.006.950.001.000.015.000.000.008.503.086.337.004IMAT (mm2)r.203.015.223-.068.448-.014.682-.8001.567-.306.620.516.146.408.189.533p.105.904.074.590.000.913.000.000.000.015.000.000.247.001.132.000Cortical Density (mg/cm3)r.231.158-.040.072.108-.012.206.171-.032.153-.136.166.229.191.260.047.207p.064.209.754.571.392.925.100.173.797.230.288.193.067.128.037.713.098Cortical Area (mm2)r.697.248-.083.096.128-.521.709-.108.335.708-.006.518.761-.197.804-.214.710p.000.046.512.446.308.000.000.390.006.000.962.000.000.115.000.087.000Cortical Thickness (mm)r.564.264-.169.193.068-.366.534.031.206.511-.022.365.542-.098.594-.181.498p.000.033.179.124.589.003.000.806.100.000.863.003.000.438.000.149.000Proximal Radius??????????????????Muscle CSA (mm2)r.758.198.046-.160.228-.574.796-.304.5671-.157.746.807-.303.915-.301.731p.000.120.718.212.072.000.000.015.000.219.000.000.016.000.017.000Muscle density (mg/cm3)r-.014.156-.540.370-.382-.092-.121.511-.306-.1571-.566-.234-.221-.159-.106-.250p.911.224.000.003.002.474.344.000.015.219.000.065.082.212.407.048IMAT (mm2)r.555.125.367-.376.441-.259.674-.542.620.746-.5661.698-.047.715-.063.660p.000.330.003.002.000.040.000.000.000.000.000.000.713.000.622.000Cortical Density (mg/cm3)r.143-.098-.235.206-.137-.003-.033.335-.196-.049.293-.308.000-.023.021.060-.008p.257.436.059.100.276.981.797.006.117.703.020.0141.000.857.865.638.950Cortical Area (mm2)r.714.111.004-.037.097-.615.674-.094.290.857-.011.604.732-.365.853-.349.654p.000.380.975.773.441.000.000.455.019.000.933.000.000.003.000.004.000Cortical Thickness (mm)r.486-.132-.207.186-.074-.477.398.149.053.567.232.123.436-.333.557-.303.371p.000.294.098.138.561.000.001.235.673.000.067.337.000.007.000.014.002Mass Measures??????????????????Appendicular Lean Mass (kg)r.677.065.218-.145.460-.495.807-.326.516.807-.234.6981-.076.909-.051.988p.000.605.082.249.000.000.000.008.000.000.065.000.546.000.687.000Arm Fat (kg)r-.333-.219.148.000.742.814-.031-.084.146-.303-.221-.047-.0761-.229.799-.016p.007.080.240.999.000.000.807.503.247.016.082.713.546.067.000.898Arms Lean Mass (kg)r.734.139.070-.171.247-.621.807-.215.408.915-.159.715.909-.2291-.298.834p.000.270.579.174.047.000.000.086.001.000.212.000.000.067.016.000Leg Fat (kg)r-.302-.160.209.110.682.809-.048-.121.189-.301-.106-.063-.051.799-.2981.043p.015.204.095.385.000.000.703.337.132.017.407.622.687.000.016.735Legs Lean Mass (kg)r.626.035.262-.129.517-.426.770-.352.533.731-.250.660.988-.016.834.0431p.000.781.035.307.000.000.000.004.000.000.048.000.000.898.000.735Questionnaire??????????????????Bad Health Daysr-.168-.085.179-.109.041-.007-.122-.123.034-.194-.255-.061-.024.079-.114-.072.011p.178.496.150.384.743.958.332.331.785.127.044.636.851.531.366.566.933Bad Mental Health Daysr-.194.001.037-.082-.034-.066-.075-.304.148-.059-.149-.033-.052-.041-.023-.082-.060p.119.996.765.511.784.600.551.014.238.649.245.795.683.743.853.518.636Vegetable Servings Dailyr-.057-.024-.056.263-.066.053-.106.131.002-.032.160-.123-.089-.020-.108.105-.078p.652.850.657.033.601.673.402.297.987.803.210.338.481.876.392.403.537Fruit Servings Dailyr.000.012-.252.228-.295-.122-.104-.006-.097-.092.224-.178-.184-.282-.138-.153-.193p.999.923.041.066.016.332.410.962.441.472.077.162.142.023.272.224.124Hours Outdoors Weekdayr.302.195-.084-.011-.203-.226.103-.131.083.286.169.204.074-.286.168-.292.036p.014.116.503.931.102.070.413.300.512.023.185.109.559.021.182.018.777Hours Outdoors Weekendr.237.021-.119-.069-.206-.266.118.098-.001.258.191.108.052-.273.141-.259.017p.055.868.343.580.097.032.349.437.991.041.135.401.682.028.262.037.896Vigorous Activity Timer-.071.050-.063.143-.215.038-.143.016-.046-.051.165-.146-.157-.119-.094-.002-.173p.575.692.616.254.085.769.260.900.720.695.200.259.214.350.462.988.170Vigorous Physical Activity Timer.001.023-.126.138-.307-.316-.012.149-.142.054.242-.172-.038-.352.050-.315-.068p.996.857.318.272.013.011.927.239.263.679.058.180.768.004.696.011.593Moderate Physical Activity Timer.205.277-.092.080-.201-.225.008.127-.110.142.271-.070.025-.238.110-.243-.008p.099.025.462.521.105.071.951.314.383.268.032.583.844.057.385.051.952Table 10. Partial Correlation adjusted for total body weight, comparing bone parameters????????????Proximal TibiaProximal RadiusHand Grip Strength (kg) Leg Extension Strength (kg)Average Stair ClimbTimed Mean gait speed (m/s)Subtotal BMD (g/cm2)Left Arm BMD (g/cm2)Right Arm BMD (g/cm2)Left Leg BMD (g/cm2)Right Leg BMD (g/cm2)Cortical Density (mg/cm3)Cortical Area (mm2)Cortical Thickness (mm)Cortical Density (mg/cm3)Cortical Area (mm2)Cortical Thickness (mm)Blood Biochemistry????????????????Vitamin D (nmol/L)r.105.346.207.011-.115.014.008-.218-.166.027.093.043-.114.097-.143p.430.007.116.936.384.915.955.097.208.842.482.746.388.465.279Glucose (mmol/L)r-.193-.237.055-.249.017-.012-.038-.015.059-.041-.146-.133-.180-.010.002p.143.071.680.057.899.930.775.913.655.759.271.316.173.939.986C-Reactive Protein (mg/L)r-.287-.210.138-.083-.185-.240-.195-.108-.141-.161-.453-.325.039-.423-.247p.027.110.299.532.160.067.139.416.286.222.000.012.770.001.059Cholesterol (mmol/L)r-.124-.079.233.034-.138-.101-.140-.065-.119-.092-.204-.155.234-.212-.086p.350.554.075.800.298.446.291.622.369.489.121.242.074.107.518Triglycerides (mmol/L)r-.022-.333.035.102-.059-.134-.148-.032-.021.024-.084-.044.040.035.137p.870.010.790.441.658.312.264.807.873.856.526.740.766.792.302High-Density Lipoprotein (mmol/L)r-.222.085.155-.036-.176-.069-.012-.149-.162-.141-.272-.204.045-.309-.243p.091.522.241.787.181.602.926.260.221.288.037.121.737.017.064Low-Density Lipoprotein (mmol/L)r-.071-.022.212.022-.084-.054-.122-.014-.077-.065-.134-.105.247-.167-.066p.595.866.107.867.528.682.356.916.564.623.313.430.059.207.621Insulin (mIU/L)r-.224-.201.136-.148.016-.220-.071-.070.147.052-.128-.037-.161-.152-.175p.087.128.306.265.905.094.593.596.265.696.334.782.223.251.185Physical Performance????????????????Hand Grip Strength (kg)r1.000.458-.317.082.288.415.325.192.191.163.608.492.172.586.375p.000.014.535.027.001.012.145.147.217.000.000.193.000.003 Leg Extension Strength (kg)r.4581.000-.309.144.187.247.234.130.144.159.335.310-.118.182-.133p.000.017.278.157.059.074.326.278.229.010.017.373.169.315Average Stair Climbr-.317-.3091.000-.549-.152-.202-.041-.169-.188-.085-.307-.317-.205-.128-.248p.014.017.000.251.125.760.202.154.521.018.014.119.334.058Timed Mean gait speed (m/s)r.082.144-.5491.000.078.132.030.081.107.102.211.269.216.064.271p.535.278.000.556.320.822.544.419.442.109.039.101.630.038Anthropometry????????????????Subtotal BMD (g/cm2)r.288.187-.152.0781.000.545.578.885.895.423.643.629.209.534.419p.027.157.251.556.000.000.000.000.001.000.000.113.000.001Left Arm BMD (g/cm2)r.415.247-.202.132.5451.000.554.318.280.236.524.398.204.641.504p.001.059.125.320.000.000.014.032.072.000.002.120.000.000Right Arm BMD (g/cm2)r.325.234-.041.030.578.5541.000.399.313.231.448.358.048.465.201p.012.074.760.822.000.000.002.016.078.000.005.718.000.128Left Leg BMD (g/cm2)r.192.130-.169.081.885.318.3991.000.887.320.515.530.197.339.306p.145.326.202.544.000.014.002.000.014.000.000.136.009.019Right Leg BMD (g/cm2)r.191.144-.188.107.895.280.313.8871.000.421.554.610.184.329.310p.147.278.154.419.000.032.016.000.001.000.000.163.011.017Proximal Tibia????????????????Muscle CSA (mm2)r.524.169-.229-.009.235.382.248.170.176.054.567.394.017.548.338p.000.200.082.947.073.003.058.197.183.686.000.002.899.000.009Muscle density (mg/cm3)r.106.112-.347.237.131-.132-.160.156.268.379.152.297.296-.033.104p.426.397.007.071.323.318.227.238.040.003.250.022.023.805.435IMAT (mm2)r.109.080.027-.022.037.210.161.063-.020-.279.075-.038-.137.193.083p.411.547.840.868.782.111.222.633.879.033.570.774.300.144.531Cortical Density (mg/cm3)r.163.159-.085.102.423.236.231.320.4211.000.518.720.430.249.266p.217.229.521.442.001.072.078.014.001.000.000.001.057.042Cortical Area (mm2)r.608.335-.307.211.643.524.448.515.554.5181.000.905.271.758.553p.000.010.018.109.000.000.000.000.000.000.000.038.000.000Cortical Thickness (mm)r.492.310-.317.269.629.398.358.530.610.720.9051.000.364.582.493p.000.017.014.039.000.002.005.000.000.000.000.005.000.000Proximal Radius????????????????Muscle CSA (mm2)r.667.313-.119-.101.291.425.369.186.174.065.596.415-.021.778.493p.000.016.369.449.025.001.004.159.187.626.000.001.877.000.000Muscle density (mg/cm3)r.210.122-.404.347.074.110-.171.031.078-.096.242.124.276.204.328p.111.358.002.007.577.408.196.815.556.471.065.349.035.122.011IMAT (mm2)r.321.233.234-.397.193.276.496.122.072.041.236.156-.369.375-.106p.013.076.074.002.143.035.000.356.587.756.072.238.004.003.423Cortical Density (mg/cm3)r.172-.118-.205.216.209.204.048.197.184.430.271.3641.000.289.660p.193.373.119.101.113.120.718.136.163.001.038.005.026.000Cortical Area (mm2)r.586.182-.128.064.534.641.465.339.329.249.758.582.2891.000.758p.000.169.334.630.000.000.000.009.011.057.000.000.026.000Cortical Thickness (mm)r.375-.133-.248.271.419.504.201.306.310.266.553.493.660.7581.000p.003.315.058.038.001.000.128.019.017.042.000.000.000.000Mass Measures????????????????Appendicular Lean Mass (kg)r.685.298-.241.017.380.467.379.263.273.188.786.572.115.765.518p.000.022.066.898.003.000.003.044.037.154.000.000.388.000.000Arm Fat (kg)r-.620-.292.042.054-.217-.517-.308-.140-.055.093-.564-.321.008-.740-.462p.000.025.749.685.099.000.018.291.680.485.000.013.955.000.000Arms Lean Mass (kg)r.645.282-.178-.078.392.475.417.226.262.185.734.526.066.794.510p.000.030.177.555.002.000.001.086.045.161.000.000.619.000.000Leg Fat (kg)r-.581-.220.112.200-.328-.522-.304-.141-.196-.070-.551-.388.091-.700-.424p.000.094.396.128.011.000.019.288.137.599.000.002.495.000.001Legs Lean Mass (kg)r.670.291-.263.068.354.438.338.269.264.180.772.567.135.708.495p.000.025.044.607.006.001.009.039.043.173.000.000.308.000.000Table 11. Partial Correlation adjusted for total body weight, comparing muscle parametersProximal TibiaProximal RadiusHand Grip Strength (kg) Leg Extension Strength (kg)Average Stair Climb (s)Timed Mean gait speed (m/s)Muscle CSA (mm2)Muscle density (mg/cm3)IMAT (mm2)Muscle CSA (mm2)Muscle density (mg/cm3)IMAT (mm2)Appendicular Lean Mass (kg)Arm Fat (kg)Arms Lean Mass (kg)Leg Fat (kg)Legs Lean Mass (kg)Blood Biochemistry?????????????????Vitamin D (nmol/L)r.105.346.207.011.093-.234.166.012.179.159.113-.218.053-.002.139p.430.007.116.936.483.074.208.928.176.231.396.097.689.987.293Glucose (mmol/L)r-.193-.237.055-.249-.150-.040-.169.054-.259.184-.027-.002.139-.337-.116p.143.071.680.057.256.764.200.685.048.162.840.989.295.009.382C-Reactive Protein (mg/L)r-.287-.210.138-.083-.373-.114-.045-.424-.229-.139-.523.444-.477.350-.520p.027.110.299.532.004.389.734.001.081.294.000.000.000.007.000Cholesterol (mmol/L)r-.124-.079.233.034-.290.028-.092-.371.053-.245-.339.137-.425.433-.275p.350.554.075.800.026.832.487.004.688.061.009.300.001.001.035Triglycerides (mmol/L)r-.022-.333.035.102-.077.195-.152-.003.001-.124-.063.068-.008-.062-.089p.870.010.790.441.562.138.250.984.992.348.637.610.954.640.501High-Density Lipoprotein (mmol/L)r-.222.085.155-.036-.358-.128-.010-.378-.183-.068-.445.228-.488.448-.398p.091.522.241.787.005.336.938.003.166.607.000.083.000.000.002Low-Density Lipoprotein (mmol/L)r-.071-.022.212.022-.215.029-.073-.320.126-.235-.247.077-.347.383-.179p.595.866.107.867.101.825.583.014.341.073.060.560.007.003.176Insulin (mIU/L)r-.224-.201.136-.148-.172.292-.176-.071-.147.014-.192.324-.052-.064-.259p.087.128.306.265.193.025.183.596.266.917.145.012.698.630.048Physical Performance?????????????????Hand Grip Strength (kg)r1.000.458-.317.082.524.106.109.667.210.321.685-.620.645-.581.670p.000.014.535.000.426.411.000.111.013.000.000.000.000.000 Leg Extension Strength (kg)r.4581.000-.309.144.169.112.080.313.122.233.298-.292.282-.220.291p.000.017.278.200.397.547.016.358.076.022.025.030.094.025Average Stair Climb (s)r-.317-.3091.000-.549-.229-.347.027-.119-.404.234-.241.042-.178.112-.263p.014.017.000.082.007.840.369.002.074.066.749.177.396.044Timed Mean gait speed (m/s)r.082.144-.5491.000-.009.237-.022-.101.347-.397.017.054-.078.200.068p.535.278.000.947.071.868.449.007.002.898.685.555.128.607Anthropometry?????????????????Subtotal BMD (g/cm2)r.288.187-.152.078.235.131.037.291.074.193.380-.217.392-.328.354p.027.157.251.556.073.323.782.025.577.143.003.099.002.011.006Left Arm BMD (g/cm2)r.415.247-.202.132.382-.132.210.425.110.276.467-.517.475-.522.438p.001.059.125.320.003.318.111.001.408.035.000.000.000.000.001Right Arm BMD (g/cm2)r.325.234-.041.030.248-.160.161.369-.171.496.379-.308.417-.304.338p.012.074.760.822.058.227.222.004.196.000.003.018.001.019.009Left Leg BMD (g/cm2)r.192.130-.169.081.170.156.063.186.031.122.263-.140.226-.141.269p.145.326.202.544.197.238.633.159.815.356.044.291.086.288.039Right Leg BMD (g/cm2)r.191.144-.188.107.176.268-.020.174.078.072.273-.055.262-.196.264p.147.278.154.419.183.040.879.187.556.587.037.680.045.137.043Proximal Tibia????????????????Muscle CSA (mm2)r.524.169-.229-.0091.000-.184.511.641.161.370.734-.578.666-.515.733p.000.200.082.947.163.000.000.222.004.000.000.000.000.000Muscle density (mg/cm3)r.106.112-.347.237-.1841.000-.664-.139.364-.366-.055.325-.045.143-.057p.426.397.007.071.163.000.294.005.004.680.012.733.281.668IMAT (mm2)r.109.080.027-.022.511-.6641.000.336-.100.333.216-.440.152-.196.240p.411.547.840.868.000.000.009.453.010.100.000.250.137.067Cortical Density (mg/cm3)r.163.159-.085.102.054.379-.279.065-.096.041.188.093.185-.070.180p.217.229.521.442.686.003.033.626.471.756.154.485.161.599.173Cortical Area (mm2)r.608.335-.307.211.567.152.075.596.242.236.786-.564.734-.551.772p.000.010.018.109.000.250.570.000.065.072.000.000.000.000.000Cortical Thickness (mm)r.492.310-.317.269.394.297-.038.415.124.156.572-.321.526-.388.567p.000.017.014.039.002.022.774.001.349.238.000.013.000.002.000Proximal Radius????????????????Muscle CSA (mm2)r.667.313-.119-.101.641-.139.3361.000.023.582.825-.798.861-.781.761p.000.016.369.449.000.294.009.862.000.000.000.000.000.000Muscle density (mg/cm3)r.210.122-.404.347.161.364-.100.0231.000-.478.231-.160.101.005.289p.111.358.002.007.222.005.453.862.000.079.228.448.970.026IMAT (mm2)r.321.233.234-.397.370-.366.333.582-.4781.000.377-.478.477-.495.302p.013.076.074.002.004.004.010.000.000.003.000.000.000.020Cortical Density (mg/cm3)r.172-.118-.205.216.017.296-.137-.021.276-.369.115.008.066.091.135p.193.373.119.101.899.023.300.877.035.004.388.955.619.495.308Cortical Area (mm2)r.586.182-.128.064.548-.033.193.778.204.375.765-.740.794-.700.708p.000.169.334.630.000.805.144.000.122.003.000.000.000.000.000Cortical Thickness (mm)r.375-.133-.248.271.338.104.083.493.328-.106.518-.462.510-.424.495p.003.315.058.038.009.435.531.000.011.423.000.000.000.001.000Mass Measures????????????????Appendicular Lean Mass (kg)r.685.298-.241.017.734-.055.216.825.231.3771.000-.806.937-.738.982p.000.022.066.898.000.680.100.000.079.003.000.000.000.000Arm Fat (kg)r-.620-.292.042.054-.578.325-.440-.798-.160-.478-.8061.000-.748.721-.795p.000.025.749.685.000.012.000.000.228.000.000.000.000.000Arms Lean Mass (kg)r.645.282-.178-.078.666-.045.152.861.101.477.937-.7481.000-.831.853p.000.030.177.555.000.733.250.000.448.000.000.000.000.000Leg Fat (kg)r-.581-.220.112.200-.515.143-.196-.781.005-.495-.738.721-.8311.000-.648p.000.094.396.128.000.281.137.000.970.000.000.000.000.000Legs Lean Mass (kg)r.670.291-.263.068.733-.057.240.761.289.302.982-.795.853-.6481.000p.000.025.044.607.000.668.067.000.026.020.000.000.000.000Participant Information and Consent FormWestern Centre for Health, Research & Education (Sunshine Hospital)Full Project Title: Dynapenic obesity, musculoskeletal and cardiometabolic health in older adults.HREC No: 2013.294Principal Researcher: Dr. David Scott (The University of Melbourne)Associate Researchers: Professor Peter Ebeling (Western Health and The University of Melbourne, Australia)IntroductionYou are invited to take part in this research project because you have been identified as being aged 50 years or older and currently overweight or obese. The research project is aiming to investigate how overweight or obesity combined with poor muscle strength impacts on bone, muscle and cardiovascular health in adults.This Participant Information and Consent Form tells you about the research project. It explains the procedures involved. Knowing what is involved will help you decide if you want to take part in the research.Please read this information carefully. Ask questions about anything that you don’t understand or want to know more about. Before deciding whether or not to take part, you might want to talk about it with a relative, friend or healthcare worker.Participation in this research is voluntary. If you don’t wish to take part, you don’t have to. You will receive the best possible care whether you take part or not.If you decide you want to take part in the research project, you will be asked to sign the consent section. By signing it you are telling us that you:understand what you have read;consent to take part in the research project;consent to participate in the research processes that are described;consent to the use of your personal and health information as described You will be given a copy of this Participant Information and Consent Form to keep.What is the purpose of this research project?The aims of this project are to investigate how overweight or obesity combined with poor muscle strength impacts on bone, muscle and cardiovascular health in adults.Overweight or obese older adults may have poor muscle and bone quality and this may increase their risk of falls and fractures. Recently, research has focused on “Dynapenic Obesity”, which means combined low muscle strength and obesity. We believe older adults with dynapenic obesity may be at even greater risk of falls and fractures, and their cardiovascular health may be worse, than overweight or obese older adults with normal muscle strength. This study will compare factors related to falls, disability, bone health and cardiovascular disease in dynapenic obese and overweight or obese alone olderadults.We will recruit 100 participants for this study which will be completed at the Western Centre for Health, Research and Education at Sunshine Hospital.This is a pilot study and the findings will be used to develop larger studies aimed at reducing the risk of falls and fractures in older adults with obesity. The project involves researchers from The University of Melbourne and Western Health.The research has been funded by The University of Melbourne Early Career Researcher Grants Scheme.What does participation in this research project involve?If you agree to participate in this project, we will arrange a time for you to attend the Western Centre for Health, Research and Education at Sunshine Hospital. The clinic visit will last around two to three hours. You will be asked to perform the following tests:You will have a blood pressure test and have a blood sample taken. This sample will be analysed to assess the levels of measures related to cardiovascular and metabolic health in your blood. Specifically, we will measure your levels for cholesterol, triglycerides, glucose, insulin, C-reactive protein and vitamin D. We will need you to fast from 10:00pm of the night before this blood test. The test will be conducted early the following morning and we will provide you with some refreshments once the test is completed.A questionnaire that will ask questions about: your gender, age, heritage, level of education, employment and marital status, general physical and mental health, specific health diagnoses, physical activity, diet and smoking status, medications you are using, your level of disability and independence, quality of life, and your perceptions of your ability to avoid falls.Your height, weight and waist circumference will be measured.You will have Dual-Energy X-ray Absorptiometry (DXA) of your whole body and peripheral Quantitative Computed Tomography (pQCT) of your lower leg and forearm. These tests follow similar procedures to a typical X-ray and will assess your body composition, and muscle and bone quality.You will perform a hand grip strength and leg strength test.Your balance will be assessed standing on one foot, standing with feet side-by-side and standing with one foot in front of the other. You will be required to hold these positions for 10 to 30 seconds, or until you are no longer able.You will be asked to rise from a chair five times without stopping in between.You will perform a test of your walking speed in which you will walk at your normal pace from one side of a room to the other.You will perform a test of your stair-climbing ability in which you will walk as fast as you safely can up a 10-step flight of stairs.What will happen to my test samples?We are taking a single blood sample in order to measure your levels for cholesterol, triglycerides, glucose, insulin, C-reactive protein and vitamin D. These measures will primarily be used to assess whether there is an association between low muscle strength and increased cardiovascular risk in overweight and obese adults. All of your unused blood sample will be discharged by the laboratory; in other words, we will not keep or store your blood sample.Blood samples will be re-identifiable; which means they will be coded so that only the researchers can identify which participants provided which samples. Your results will be saved on a secure internet service provided by Dorevitch Pathology, and only the researchers will have access to this data.Your blood sample will not be stored. As such, it cannot be used for any other research project in the future and you will be providing consent for its use for this research project only.What are the possible benefits?We cannot guarantee or promise that you will receive any benefits from this research however this research may lead to a greater understanding of how low muscle strength in overweight or obesity contributes to falls, fractures and cardiovascular diseases, and will enable us to develop treatments to reduce the risk of these health disorders in older adults. We will provide you with detailed information on your study results and explain these clearly in a follow-up call. We will also forward these results to your nominated general practitioner as they may be useful in your future health care.What are the possible risks?There may be some risks to you in participating in this research. Possible risks, side effects and discomforts include:Blood testsHaving blood (or tissue sample) taken may cause some discomfort or bruising. Sometimes, the blood vessel may swell, or blood may clot in the blood vessel, or the spot from which tissue is taken could become inflamed. Rarely, there could be a minor infection or bleeding. If this happens, it can be easily treated.Physical performance testsThere is a risk that you may experience an injury when participating in physical performance tests. However, these tests are routinely used in research and clinical practice with older adults and the risks are low. You will be supervised at all times while performing tests. Sometimes following physical activity you can experience soreness or discomfort in your muscles. These effects are usual effects of exercise and will resolve in three to four days.Exposure to ionising radiationThis research study involves exposure to a very small amount of radiation. As part of everyday living, everyone is exposed to naturally occurring background radiation and receives a dose of about 2 millisieverts (mSv) each year. The effective dose from this study is less than 0.1 mSv. At this dose level, no harmful effects of radiation have been demonstrated as any effect is too small to measure. The risk is believed to be minimal.Psychological distressIf you become upset or distressed as a result of your participation in the research, the researcher is able to arrange for counselling or other appropriate support. Any counselling or support will be provided by staff who are not members of the research team. In addition, you may prefer to suspend or end your participation in the research if distress occurs.Are there alternatives to participation?You do not have to participate in this study to receive any medical care you may require.Do I have to take part in this research project?Participation in any research project is voluntary. If you do not wish to take part you don’t have to. If you decide to take part and later change your mind, you are free to withdraw from the project at any stage.Your decision whether to take part or not to take part, or to take part and then withdraw, will not affect your treatment with Western Health.What if I withdraw from this research project?If you decide to withdraw, please notify a member of the research teamIf you decide to leave the project, the researchers will keep the information that has already been collected. This is to help them make sure that the results of the research can be measured properly. If you do not want them to do this, you should not join the research project.How will I be informed of the results of this research project?Once the study is complete and the results are known, you will receive a plain English summary of results by mail. You will also receive a summary of your individual results, including information from your blood tests, body composition measurements and physical performance tests.What else do I need to know?What will happen to information about me?All data collected in this study will be re-identifiable (coded). Only the researchers will have access to these codes and will be able to link your data to you. Any information obtained for the purpose of this research project that can identify you will be treated as confidential and securely stored. It will be disclosed only with your permission, or as permitted by law.Hard copies of data will be stored in a locked cabinet within a secure office building located at Sunshine Hospital, and electronic data will be stored on a password-protected computer. All data will be stored in this manner for a period of five years after the publication of results, and then will be destroyed.We will publish results from this research through scientific journals, reports and presentations. In any publication and/or presentation, information will be provided in such a way that you cannot be identified, except with your permission. Your confidentiality will be maintained as we will not publish individual results; all data in our reports will be aggregated.How can I access my information?In accordance with relevant Australian and/or Victorian privacy and other relevant laws, you have the right to access the information collected and stored by the researchers about you. You also have the right to request that any information, with which you disagree, be corrected. Please contact one of the researchers named at the end of this document if you would like to access your information.What happens if I am injured as a result of participating in this research project?If you suffer an injury as a result of participating in this research project, hospital care and treatment will be provided by the public health service at no extra cost to you if you elect to be treated as a public patient.Is this research project approved?The ethical aspects of this research project have been approved by the Melbourne Health Human Research Ethics Committee.This project will be carried out according to the National Statement on Ethical Conduct in Human Research (2007) produced by the National Health and Medical Research Council of Australia. This statement has been developed to protect the interests of people who agree to participate in human research studies.ConsentI have read, or have had read to me in a language that I understand, this document and I understand the purposes, procedures and risks of this research project as described within it.I have had an opportunity to ask questions and I am satisfied with the answers I have received.I freely agree to participate in this research project as described.Blood Sample CollectionI consent to my blood sample being taken and used in this researchInitial:Date:ORI do not consent to blood sample collection.Initial:Date:I understand that I will be given a signed copy of this document to keep. Participant’s name (printed) ……………………………………………………SignatureDateName of witness * (printed) ………………………………………SignatureDate*Witness required when the participant cannot read this form for him/her selfDeclaration by researcher*: I have given a verbal explanation of the research project, its procedures and risks and I believe that the participant has understood that explanation.Researcher’s name (printed) ……………………………………………………HREC 2013.294SignatureDateSignatureDate* A senior member of the research team must provide the explanation and provision of information concerning the research project.Note: All parties signing the consent section must date their own signature.Who can I contact?Who you may need to contact will depend on the nature of your query, therefore, please note the following:For further information or appointments:If you want any further information concerning this project or if you have any medical problems which may be related to your involvement in the project (for example, any side effects), you can contact the principal researcher or associate researcher (details below), or the Western Hospital on (03) 8345 6666 (24 hour number) and ask for the orthopaedic registrar on call.Name: Dr. David Scott Role: Principal Researcher Telephone: (03) 8395 8108Name: Professor Peter EbelingRole: Associate Researcher/Head of Endocrinology Telephone: 0417 130 225For complaints:If you have any complaints about any aspect of the project, the way it is being conducted or any questions about being a research participant in general, then you may contact:Name: Angela GrayPosition: Manager Melbourne Health Human Research Ethics CommitteeTelephone: (03) 9342 8530Name: Dr. Tam NguyenPosition: Manager of Western Health Office for Research Telephone: (03) 8395 8073The Dynapenic Obesity StudyDATA COLLECTION BOOKLETParticipant ID: Date:// Time::AM / PMStation 1 - Informed Consent, Blood Collection, QuestionnaireInvestigator initials: Informed ConsentPICF read, any questions answered, and form signed by participant (please tick)□Blood PressureTime::AM / PMBlood pressure measured in right arm (please circle):Yes / NoSBP: Trial 1:mm/HgTrial 2:mm/HgTrial 3:mm/HgDBP: Trial 1:mm/HgTrial 2:mm/HgTrial 3:mm/HgComments:Record SBP and DBP (last of trial 2 or 3) on participant’s data record sheet.Blood CollectionProvide participant with Dorevitch Pathology referral form and escort them to pathology. Time::AM / PMBlood Collection Completed (please circle): Yes / No Comments:QuestionnaireProvide participant with refreshments and the study questionnaire. Provide clarifications if the participant requires these and ensure all sections are completed.DocumentCompletedCommentYesNoGeneral QuestionnaireEQ5DAQoLModified Falls Efficacy ScaleAsk the participant to remove footwear, headwear and any bulky items of clothing.Height cmBMI:kg/m2Weight kgWaist CircumferenceTrial 1:cmTrial 2:cmTrial 3:cmWHR: Hip CircumferenceTrial 1:cmTrial 2:cmTrial 3:cmComments:Record height, weight, BMI and WHR on the participant’s data record sheet.Station 2 - ImagingDXAInvestigator initials: Time::AM / PMImaging Completed (please circle):Yes / No Comments:pQCTInvestigator initials: Time::AM / PMImaging Completed (please circle):Tibia (non-dominant limb)Yes / NoRadius (non-dominant limb)Yes / NoComments:Station 3 – Strength and Balance TestsInvestigator initials: Hand Grip StrengthParticipant’s nominated dominant hand (please circle):Left / RightLeft Hand:Trial 1:kgTrial 2:kgTrial 3:kgRight Hand: Trial 1:kgTrial 2:kgTrial 3:kgComments:Record highest value on participant’s data record sheet.Quadriceps StrengthParticipant’s nominated dominant leg (please circle):Left / RightLeft Leg:Trial 1:kgTrial 2:kgTrial 3:kgRight Leg:Trial 1:kgTrial 2:kgTrial 3:kgComments:Single-limb balance testTests completed and results saved to database (please circle):Yes / No Comments:Station 4 – Physical Performance TestsInvestigator initials: Repeated Chair StandsTime:sec (if five stands are completed)Number of Stands Completed (please circle): 1 2 3 4 5 Chair Stand Ordinal Score: 0 = unable1 = > 16.7 sec2 = 16.6-13.7 sec3 = 13.6-11.2 sec4 = < 11.1 secSemi-tandem StandCircle one number:2. Held for 10 sec1. Held for less than 10 sec; number of seconds held 0. Not attemptedSide-by-side StandCircle one number:2. Held for 10 sec1. Held for less than 10 sec; number of seconds held 0. Not attemptedFull-tandem StandCircle one number:2. Held for 10 sec1. Held for less than 10 sec; number of seconds held Not attemptedBalance Ordinal Score: 0 = side by side 0-9 sec or unable1 = side by side 10, <10 sec semitandem2 = semitandem 10 sec, tandem 0-2 sec3 = semitandem 10 sec, tandem 3-9 sec4 = tandem 10 secGait SpeedTime:secGait Ordinal Score: 0 = could not do1 = >5.7 sec (<0.43 m/sec)2 = 4.1-6.5 sec (0.44-0.60 m/sec)3 = 3.2-4.0 (0.61-0.77 m/sec)4 = <3.1 sec (>0.78 m/sec)Record gait speed (m/sec) on participant’s data record sheet.Stair Climb Power TestTrial 1:Time:secTrial 2:Time:sec Comments:Ensure all sections of this booklet have been completed.Thank the participant for their time and effort, and assist with organising transport if required.Give the participant their personal data record sheet.Return this booklet and all questionnaires to the participant’s folder and store in locked cabinet.Pack up all equipment and store securely.Participant Record SheetThank you for participating in our study. Below are your results for measures we collected today.If you would like more information about these results, we suggest that you discuss them with your GP or preferred health professional.Participant ID:Date:MeasureYour resultBlood pressure (mm/Hg)Height (cm)Weight (kg)Body mass index (kg/m2)Waist-hip ratioHand grip strength (kg)Gait speed (metres/second)The Dynapenic Obesity StudyParticipant ID: Questionnaire DocumentPlease complete all questions within this document to the best of your ability. If you are unclear on the meaning of any questions or how to respond, you will be able to discuss this with one of the investigators.General QuestionnaireAre you (please tick):Male□Female □What is your date of birth?//(dd/mm/yyyy)Which best describes you (please tick)?I am an Australian citizen and was born in Australia □I am an Australian citizen or permanent resident born outside Australia□I am not a citizen or permanent resident of Australia □What is your highest level of education (please tick)? This includes complete or incompleteNo schooling □Pre-school □ Infants/primary school □ Secondary school □Technical or further educational institution (inc TAFE colleges) □University or other higher educational institution □What is your current marital status (please tick)?Single □ Widowed □ Divorced □Separated not divorced □Married or De facto □What is your current employment status (please tick)?Employed/self-employed full-time □ Employed/self-employed part-time □ Unemployed □Retired □ Student □ Home Duties □Pension (including disability or sole-parent pension) □Would you say that in general your health is (please tick):Excellent □ Very good □ Good □Fair □Poor □Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?Number of days: Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?Number of days: During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?Number of days: Have you ever been told by a doctor or other medical professional that you have any of the following physical conditions (mark all that apply):Coronary heart disease (including angina, stroke, peripheral vascular disease and heart attack) □Hypertension (high blood pressure) □ Hypercholesterolaemia (high cholesterol) □ Thrombosis (Blood clot) □Diabetes □Asthma □Chronic bronchitis or emphysema □Any form of cancer □ Osteoporosis □ Osteoarthritis □ Rheumatoid arthritis □ Hyperthyroidism □ Hypothyroidism □Other major illness (please provide details below) □Comments:In the last week, how many times have you walked continuously, for at least 10 minutes, for recreation, exercise or to get to or from places?Number of times: What do you estimate was the total time that you spent walking in this way in the last week? hours and/orminutesIn the last week, how many times did you do any vigorous gardening or heavy work around the yard, which made you breathe harder or puff and pant?Number of times: What do you estimate was the total time that you spent doing vigorous gardening or heavy work around the yard in the last week? hours and/orminutesThe next questions exclude household chores, gardening or yardwork:In the last week, how many times did you do any vigorous physical activity which made you breathe harder or puff and pant? (e.g. jogging, cycling, aerobics, competitive tennis)Number of times: What do you estimate was the total time that you spent doing this vigorous physical activity in the last week? hours and/orminutesIn the last week, how many times did you do any other more moderate physical activities that you have not already mentioned? (e.g. gentle swimming, social tennis, golf)Number of times: What do you estimate was the total time that you spent doing these activities in the last week? hours and/orminutesHow many serves of vegetables do you eat on a usual day? One serve of vegetables is equivalent to half a cup of cooked vegetables or one cup of salad vegetables. servesHow many serves of fruit do you eat on a usual day? One serve of fruit is equivalent to one medium piece or two small pieces of fruit. servesAre you now, or have you ever been, a smoker (please tick)?Yes, I am a current smoker□Yes, I am an ex-smoker□No, I have never been a smoker□About how many hours a DAY would you usually spend outdoors on a weekday and on the weekend?Weekday:hours per dayWeekend:hours per dayWhat best describes the colour of the skin on the inside of your upper arm, that is your skin colour without any tanning (please tick)?Very fair □Fair □Light olive □ Dark olive □ Brown □ Black □Please list any medications you are currently taking, including prescription and over-the-counter medications, vitamins or herbal remedies:EQ-5DUnder each heading below, please indicate which of the three statements best describes your own health state today (please tick):MobilityI have no problems in walking about □I have some problems in walking about □I am confined to bed □Self-CareI have no problems with self-care □I have some problems washing or dressing myself □I am unable to wash or dress myself □Usual Activities (e.g., work, study, housework, family, or leisure activities)I have no problems with performing my usual activities □I have some problems with performing my usual activities □I am unable to perform my usual activities □Pain/DiscomfortI have no pain or discomfort □I have moderate pain or discomfort □I have extreme pain or discomfort □Anxiety/DepressionI am not anxious or depressed □I am moderately anxious or depressed □I am extremely anxious or depressed □AQoL-6DPlease tick the statement that best describes how you feel today:How much help do you need with jobs around the house (e.g., cooking, cleaning the house or washing clothes):I can do all these tasks very quickly and efficiently without any help □I can do these tasks relatively easily without help □ I can do these tasks only very slowly without help □I cannot do most of these tasks unless I have help □ I can do none of these tasks by myself □Thinking about how easy or difficult it is for you to get around by yourself outside your house (e.g., shopping, visiting):Getting around is enjoyable and easy □I have no difficulty getting around outside my house □A little difficulty □ Moderate difficulty □ A lot of difficulty □I cannot get around unless somebody is there to help me □Thinking about your mobility, including using any aids or equipment such as wheelchairs, frames, sticks:I am very mobile □I have no difficulty with mobility □I have some difficulty with mobility (for example, going uphill) □ I have difficulty with mobility. I can go short distances only □I have a lot of difficulty with mobility. I need someone to help me □ I am bedridden □Thinking about dressing, washing yourself, eating or looking after your appearance:These tasks are very easy for me □I have no real difficulty in carrying out these tasks □I find some of these tasks difficult, but I manage to do them on my own □ Many of these tasks are difficult, and I need help to do them □I cannot do these tasks by myself at all □Your close and intimate relationships (including any sexual relationships) make you:Very happy □ Generally happy □Neither happy nor unhappy □ Generally unhappy □Very unhappy □Thinking about your health and your relationship with your family:My role in the family is unaffected by my health □There are some parts of my family role I cannot carry out □ There are many parts of my family role I cannot carry out □ I cannot carry out any part of my family role □Thinking about your health and your role in your community (that is to say neighbourhood, sporting, work, church or cultural groups): My role in the community is unaffected by my health □There are some parts of my community role I cannot carry out □ There are many parts of my community role I cannot carry out □ I cannot carry out any part of my community role □How often did you feel in despair over the last seven days?Never □ Occasionally □ Sometimes □ Often □All the time □And still thinking about the last seven days, how often did you feel worried?Never□ Occasionally □ Sometimes□ Often □All the time □How often do you feel sad?Never □ Rarely □Some of the time □ Usually □Nearly all the time □When you think about whether you are calm and tranquil or agitated:I amAlways calm and tranquil □ Usually calm and tranquil □Sometimes calm and tranquil, sometimes agitated □ Usually agitated □Always agitated □Thinking about how much energy you have to do the things you want to do:I amAlways full of energy □ Usually full of energy □ Occasionally energetic □Usually tired and lacking energy □ Always tired and lacking energy □How often do you feel in control of your life?Always □ Mostly □ Sometimes □Only occasionally □ Never □How much do you feel you can cope with life’s problems?Completely □ Mostly □ Partly □Very little □ Not at all □Thinking about how often you experience serious pain:I experience itVery rarely □Less than once a week □ Three to four times a week □ Most of the time □How much pain or discomfort do you experience:None at all □I have moderate pain □I suffer from severe pain □ I suffer unbearable pain □How often does pain interfere with your usual activities?Never □ Rarely □ Sometimes □ Often □ Always □Thinking about your vision (using your glasses or contact lenses if needed):I have excellent sight □ I see normally □I have some difficulty focusing on things, or I do not see them sharply. E.g. small print, a newspaper or seeing objects in the distance □I have a lot of difficulty seeing things. My vision is blurred. I can see just enough to get by with □I only see general shapes. I need a guide to move around □I am completely blind □Thinking about your hearing (using your hearing aid if needed):I have excellent hearing □ I hear normally □I have some difficulty hearing or I do not hear clearly. I have trouble hearing softly-spoken people or when there is background noise □I have difficulty hearing things clearly. Often I do not understand what is said. I usually do not take part in conversations because I cannot hear what is said □I hear very little indeed. I cannot fully understand loud voices speaking directly to me □I am completely deaf □When you communicate with others, e.g. by talking, listening, writing or signing:I have no trouble speaking to them or understanding what they are saying □I have some difficulty being understood by people who do not know me. I have no trouble understanding what others are saying to me □I am understood only by people who know me well. I have great trouble understanding what others are saying to me □ I cannot adequately communicate with others □The Modified Falls Efficacy ScaleThe final set of questions asks you how confident you are that you can avoid having a fall when performing different activities.On a scale of 0 to 10, how confident are you that you can do each of these activities without falling, with 0 meaning “not confident/not sure at all”, 5 being “fairly confident/fairly sure”, and 10 being “completely confident/completely sure”?Please answer each question by making a mark on the line with your pen. For example, a score of 6.5 would be marked on the scale as follows:Not confidentFairlyCompletely346583025336500EXAMPLE:at allconfidentconfident 012345678910NOTE:If you have stopped doing the activity at least partly because of being afraid of falling, please score the activity 0;If you do not currently do the activity for other reasons, please rate that item based on how you perceive you would rate if you had to do the activity today.Get dressed and undressedPrepare a simple mealTake a bath or a showerGet in/out of a chairGet in/out of bedAnswer the door or telephone3475355578294500Walk around the inside of your houseReach into cabinets or closetLight housekeepingSimple shoppingUsing public transportCrossing roadsthe washing*14.Using front or rear steps at home* Please rate the activity you perform most oftenThank you, the questionnaire has ended. ................
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