JAGS
MARCH 2014–VOL. 62, NO. 3
Nelson Sousa, PhD Romeu Mendes, MD Research Center in Sport Sciences, Health Sciences and Human Development, University of Tra´s-os-Montes e Alto Douro, Vila Real, Portugal Jose´ Oliveira, PhD Research Center in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal
ACKNOWLEDGMENTS Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Sousa and Mendes discussed and prepared the manuscript. Oliveira supervised. Sponsor’s Role: None.
REFERENCES 1. Safer U, Safer VB. Comment on: “Is Once-weekly resistance training enough to prevent sarcopenia?”. J Am Geriatr Soc 2013;62:589–590. 2. Sousa N, Mendes R, Abrantes C et al. Is once-weekly resistance training enough to prevent sarcopenia? J Am Geriatr Soc 2013;61:1423–1424. 3. Haapala I, Hirvonen A, Niskanen L et al. Anthropometry, bioelectrical impedance and dual-energy X-ray absorptiometry in the assessment of body composition in elderly Finnish women. Clin Physiol Funct Imaging 2002;22:383–391. 4. Roubenoff R, Baumgartner RN, Harris TB et al. Application of bioelectrical impedance analysis to elderly populations. J Gerontol A Biol Sci Med Sci 1997;52A:M129–M136. 5. Sillanp€ a€ a E, Cheng S, H€akkinen K et al. Body composition in 18- to 88year-old adults—comparison of multifrequency bioimpedance and dualenergy X-ray absorptiometry. Obesity (Silver Spring) 2013 [Epub ahead of print].
RE: EFFECTS OF RESISTANCE VERSUS MULTICOMPONENT TRAINING ON BODY COMPOSITION AND FUNCTIONAL FITNESS IN INSTITUTIONALIZED ELDERLY WOMEN To the Editor: We read with great interest the study by Sousa and Mendes,1 who reported that 12 weeks of training protocol was not enough to induce changes in the body composition of institutionalized elderly women. The results of that study are particularly important because body composition changes with aging even in weight-stable elderly men and women.2 Beyond these, we would like to comment on some points. Body composition measurement in the study was made using bioelectrical impedance analysis (BIA). For body composition analysis in elderly adults, accuracy of BIA is under discussion.3 The theory of BIA measurement relies on the capacity of hydrated tissues to conduct electrical energy, which allows estimation of total body water (TBW). Calculation of lipid and fat-free mass with BIA was made using equations on TBW,4 so changes in TBW may easily affect BIA results, and pretest preparation is mandatory to minimize the effect of
LETTERS TO THE EDITOR
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the confounders. The pretest protocol was not reported. Moreover, a recent study showed that a 12-week training program had a significant effect on changes in body fat, total lean mass, and total fat mass in an elderly population.5 In Sousa and Mendes’s study, body composition was measured using dual-energy X-ray absorptiometry, which is the recommended alternative to criterion standard methods. We believe that these problems may have affected the results. Umut Safer, MD Department of Geriatrics, Gulhane School of Medicine, Ankara, Turkey Vildan Binay Safer, MD Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
ACKNOWLEDGMENTS Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Umut Safer and Vildan Binay Safer discussed and prepared the manuscript. Sponsor’s Role: None.
REFERENCES 1. Sousa N, Mendes R. Effects of resistance versus multicomponent training on body composition and functional fitness in institutionalized elderly women. J Am Geriatr Soc 2013;61:1815–1817. 2. Zamboni M, Zoico E, Scartezzini T et al. Body composition changes in stable-weight elderly subjects: The effect of sex. Aging Clin Exp Res 2003;15:321–327. 3. Safer U, Tasci I, Binay Safer V et al. Is segmental bioelectrical impedance analysis a valid tool to assess muscle mass in the elderly? Geriatr Gerontol Int 2013;13:1085–1086. 4. Thibault R, Genton L, Pichard C. Body composition: Why, when and for who? Clin Nutr 2012;31:435–447. 5. Romero-Arenas S, Blazevich AJ, Martinez-Pascual M et al. Effects of high-resistance circuit training in an elderly population. Exp Gerontol 2013;48:334–340.
RESPONSE TO DRS. SAFER AND SAFER To the Editor: We are grateful to Safer and Safer1 for commenting on the methodology used to measure body composition in our recent study.2 The validity of bioelectrical impedance analysis for assessing body composition is an important question, particularly when institutionalized elderly adults, whose daily life is spent almost exclusively within the institution, are being evaluated. Institutionalized elderly adults have particular characteristics that must be taken into account in this type of study. It has been reported that 65% of institutionalized elderly adults spend their time doing little or nothing, 12% of their time in social activities, and the majority of their time in their rooms, sitting and alone.3 Another study reported that most institutionalized elderly adults
592
LETTERS TO THE EDITOR
spend at least 17 hours per day in bed.4 The authors of the current letter believe that most institutionalized elderly adults in Portugal are in a similar situation. One of the consequences of this physical inactivity cycle is the restriction of activities of daily living to the physical space of the institution, including regular medical care, making it difficult to study this population outside institutions. Therefore, assessing body composition using dual energy X-ray absorptiometry or other nonportable instruments is not the best strategy for this population. Despite not being the criterion standard method, bioelectrical impedance analysis (TANITA TBF-215, Tokyo, Japan) can be assessed using a portable instrument and is an easily performed, noninvasive way to analyze body composition. Moreover, recent studies continue to use this methodology in assessing body composition in institutionalized elderly adults.5,6 Safer and Safer argued that, in a recent study,7 a 12week training program had a significant effect on time for changes in body fat, total lean mass, and total fat mass in elderly adults measured using dual energy X-ray absorptiometry, but the population analyzed in that study, and the design of the training, with greater exercise intensity, is not comparable. Participants were healthy, independent, younger men and women (61.6 5.3, vs 72.9 6.6),7 and despite the interesting results, significant changes in body composition after 12 weeks of exercise are always more surprising than absence of change. Nelson Sousa, PhD Romeu Mendes, MD Research Center in Sport Sciences, Health Sciences and Human Development, University of Tr as-os-Montes e Alto Douro, Vila Real, Portugal
MARCH 2014–VOL. 62, NO. 3
JAGS
ACKNOWLEDGMENTS Conflict of Interest: None. Author Contributions: Nelson Sousa and Romeu Mendes discussed, prepared, and supervised the manuscript. Sponsor’s Role: None.
REFERENCES 1. Safer U, Safer VB. Re: Effects of resistance versus multicomponent training on body composition and functional fitness in institutionalized elderly women. J Am Geriatr Soc 2013;62:591. 2. Sousa N, Mendes R. Effects of resistance versus multicomponent training on body composition and functional fitness in institutionalized elderly women. J Am Geriatr Soc 2013;61:1815–1817. 3. Ice GH. Daily life in a nursing home: Has it changed in 25 years? J Aging Stud 2002;16:345–359. 4. Bates-Jensen BM, Alessi CA, Cadogan M et al. The Minimum Data Set bedfast quality indicator: Differences among nursing homes. Nurs Res 2004;53:260–272. 5. Santomauro F, Baggiani L, Mantero S et al. Assessment of nutritional status in institutionalized elderly individuals through body impedance analysis. Ig Sanita Pubbl 2008;64:67–78. 6. Camina Martın MA, de Mateo Silleras B, Carre~ no Enciso L et al. Changes in body composition in relation to the stage of dementia in a group of institutionalized elderly. Nutr Hosp 2013;28:1093–1101. 7. Romero-Arenas S, Blazevich AJ, Martinez-Pascual M et al. Effects of high-resistance circuit training in an elderly population. Exp Gerontol 2013;48:334–340.
MARCH 2014–VOL. 62, NO. 3
Nelson Sousa, PhD Romeu Mendes, MD Research Center in Sport Sciences, Health Sciences and Human Development, University of Tra´s-os-Montes e Alto Douro, Vila Real, Portugal Jose´ Oliveira, PhD Research Center in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal
ACKNOWLEDGMENTS Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Sousa and Mendes discussed and prepared the manuscript. Oliveira supervised. Sponsor’s Role: None.
REFERENCES 1. Safer U, Safer VB. Comment on: “Is Once-weekly resistance training enough to prevent sarcopenia?”. J Am Geriatr Soc 2013;62:589–590. 2. Sousa N, Mendes R, Abrantes C et al. Is once-weekly resistance training enough to prevent sarcopenia? J Am Geriatr Soc 2013;61:1423–1424. 3. Haapala I, Hirvonen A, Niskanen L et al. Anthropometry, bioelectrical impedance and dual-energy X-ray absorptiometry in the assessment of body composition in elderly Finnish women. Clin Physiol Funct Imaging 2002;22:383–391. 4. Roubenoff R, Baumgartner RN, Harris TB et al. Application of bioelectrical impedance analysis to elderly populations. J Gerontol A Biol Sci Med Sci 1997;52A:M129–M136. 5. Sillanp€ a€ a E, Cheng S, H€akkinen K et al. Body composition in 18- to 88year-old adults—comparison of multifrequency bioimpedance and dualenergy X-ray absorptiometry. Obesity (Silver Spring) 2013 [Epub ahead of print].
RE: EFFECTS OF RESISTANCE VERSUS MULTICOMPONENT TRAINING ON BODY COMPOSITION AND FUNCTIONAL FITNESS IN INSTITUTIONALIZED ELDERLY WOMEN To the Editor: We read with great interest the study by Sousa and Mendes,1 who reported that 12 weeks of training protocol was not enough to induce changes in the body composition of institutionalized elderly women. The results of that study are particularly important because body composition changes with aging even in weight-stable elderly men and women.2 Beyond these, we would like to comment on some points. Body composition measurement in the study was made using bioelectrical impedance analysis (BIA). For body composition analysis in elderly adults, accuracy of BIA is under discussion.3 The theory of BIA measurement relies on the capacity of hydrated tissues to conduct electrical energy, which allows estimation of total body water (TBW). Calculation of lipid and fat-free mass with BIA was made using equations on TBW,4 so changes in TBW may easily affect BIA results, and pretest preparation is mandatory to minimize the effect of
LETTERS TO THE EDITOR
591
the confounders. The pretest protocol was not reported. Moreover, a recent study showed that a 12-week training program had a significant effect on changes in body fat, total lean mass, and total fat mass in an elderly population.5 In Sousa and Mendes’s study, body composition was measured using dual-energy X-ray absorptiometry, which is the recommended alternative to criterion standard methods. We believe that these problems may have affected the results. Umut Safer, MD Department of Geriatrics, Gulhane School of Medicine, Ankara, Turkey Vildan Binay Safer, MD Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
ACKNOWLEDGMENTS Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Umut Safer and Vildan Binay Safer discussed and prepared the manuscript. Sponsor’s Role: None.
REFERENCES 1. Sousa N, Mendes R. Effects of resistance versus multicomponent training on body composition and functional fitness in institutionalized elderly women. J Am Geriatr Soc 2013;61:1815–1817. 2. Zamboni M, Zoico E, Scartezzini T et al. Body composition changes in stable-weight elderly subjects: The effect of sex. Aging Clin Exp Res 2003;15:321–327. 3. Safer U, Tasci I, Binay Safer V et al. Is segmental bioelectrical impedance analysis a valid tool to assess muscle mass in the elderly? Geriatr Gerontol Int 2013;13:1085–1086. 4. Thibault R, Genton L, Pichard C. Body composition: Why, when and for who? Clin Nutr 2012;31:435–447. 5. Romero-Arenas S, Blazevich AJ, Martinez-Pascual M et al. Effects of high-resistance circuit training in an elderly population. Exp Gerontol 2013;48:334–340.
RESPONSE TO DRS. SAFER AND SAFER To the Editor: We are grateful to Safer and Safer1 for commenting on the methodology used to measure body composition in our recent study.2 The validity of bioelectrical impedance analysis for assessing body composition is an important question, particularly when institutionalized elderly adults, whose daily life is spent almost exclusively within the institution, are being evaluated. Institutionalized elderly adults have particular characteristics that must be taken into account in this type of study. It has been reported that 65% of institutionalized elderly adults spend their time doing little or nothing, 12% of their time in social activities, and the majority of their time in their rooms, sitting and alone.3 Another study reported that most institutionalized elderly adults
592
LETTERS TO THE EDITOR
spend at least 17 hours per day in bed.4 The authors of the current letter believe that most institutionalized elderly adults in Portugal are in a similar situation. One of the consequences of this physical inactivity cycle is the restriction of activities of daily living to the physical space of the institution, including regular medical care, making it difficult to study this population outside institutions. Therefore, assessing body composition using dual energy X-ray absorptiometry or other nonportable instruments is not the best strategy for this population. Despite not being the criterion standard method, bioelectrical impedance analysis (TANITA TBF-215, Tokyo, Japan) can be assessed using a portable instrument and is an easily performed, noninvasive way to analyze body composition. Moreover, recent studies continue to use this methodology in assessing body composition in institutionalized elderly adults.5,6 Safer and Safer argued that, in a recent study,7 a 12week training program had a significant effect on time for changes in body fat, total lean mass, and total fat mass in elderly adults measured using dual energy X-ray absorptiometry, but the population analyzed in that study, and the design of the training, with greater exercise intensity, is not comparable. Participants were healthy, independent, younger men and women (61.6 5.3, vs 72.9 6.6),7 and despite the interesting results, significant changes in body composition after 12 weeks of exercise are always more surprising than absence of change. Nelson Sousa, PhD Romeu Mendes, MD Research Center in Sport Sciences, Health Sciences and Human Development, University of Tr as-os-Montes e Alto Douro, Vila Real, Portugal
MARCH 2014–VOL. 62, NO. 3
JAGS
ACKNOWLEDGMENTS Conflict of Interest: None. Author Contributions: Nelson Sousa and Romeu Mendes discussed, prepared, and supervised the manuscript. Sponsor’s Role: None.
REFERENCES 1. Safer U, Safer VB. Re: Effects of resistance versus multicomponent training on body composition and functional fitness in institutionalized elderly women. J Am Geriatr Soc 2013;62:591. 2. Sousa N, Mendes R. Effects of resistance versus multicomponent training on body composition and functional fitness in institutionalized elderly women. J Am Geriatr Soc 2013;61:1815–1817. 3. Ice GH. Daily life in a nursing home: Has it changed in 25 years? J Aging Stud 2002;16:345–359. 4. Bates-Jensen BM, Alessi CA, Cadogan M et al. The Minimum Data Set bedfast quality indicator: Differences among nursing homes. Nurs Res 2004;53:260–272. 5. Santomauro F, Baggiani L, Mantero S et al. Assessment of nutritional status in institutionalized elderly individuals through body impedance analysis. Ig Sanita Pubbl 2008;64:67–78. 6. Camina Martın MA, de Mateo Silleras B, Carre~ no Enciso L et al. Changes in body composition in relation to the stage of dementia in a group of institutionalized elderly. Nutr Hosp 2013;28:1093–1101. 7. Romero-Arenas S, Blazevich AJ, Martinez-Pascual M et al. Effects of high-resistance circuit training in an elderly population. Exp Gerontol 2013;48:334–340.
