Objective We tested the effect of the hearing intervention vs. health education control (1:1 randomization) on 3-year physical function decline, a secondary analysis of the ACHIEVE randomized trial (ClinicalTrials.gov Identifier: NCT03243422). Methods Pre-specified outcomes included the Short Physical Performance Battery (SPPB) [total score and components] and grip strength. Intervention effects were modeled using linear mixed models following a pre-specified statistical analysis plan. Results In 956 participants (mean 76.3 years, 53% female, 12% Black race), hearing intervention did not impact change in SPPB (difference comparing intervention to control = 0.00 standard deviation [SD] units, 95% confidence interval [CI]:-0.14, 0.14) or grip strength (difference = 0.01 SD, 95% CI: -0.06, 0.08). However, treatment effects varied by recruitment cohort; although findings were not statistically significant, they suggest a clinically meaningful benefit (slower decline) in participants with faster rates of cognitive decline. Conclusions These secondary results have direct relevance for inclusion in systematic reviews and meta-analyses. Future research should be designed to test whether hearing intervention can reduce short-term declines in physical function, particularly among those experiencing cognitive decline. Continuing follow-up of the ACHIEVE study participants will yield insights into longer-term (>3 years) effects of intervention.

Mobility assessments are essential for evaluating baseline function and monitoring responses to interventions in older adults. Usual-pace gait speed and the 6-minute walk test (6MWT) are widely used and reproducible measures with established minimum clinically important differences (MCIDs) to distinguish responders from non-responders. However, both require in-person administration, limiting their scalability in clinical trials and population-based studies. Walking cadence, a measure of walking intensity that can be captured digitally, may offer a scalable alternative for identifying responders versus non-responders to mobility interventions. We conducted a secondary analysis of the prospective Program to Improve Mobility in Aging (PRIMA) cohort trial to evaluate whether changes in walking cadence after a walking intervention could identify responders versus non-responders. Cadence was measured during usual-pace gait speed testing and the 6MWT, and logistic regression models assessed its ability to predict achievement of MCIDs for gait speed (>0.1 m/s) and 6MWT distance (>30 m) in older adults. Data from 213 participants were analyzed. Change in median walking cadence predicted improvement in usual-pace gait speed with an area under the curve (AUC) of 0.90 (95% CI: 0.85-0.94). The Youden Index identified an increase of ≥3 steps/min as the optimal threshold (sensitivity 0.81; specificity 0.88). For predicting improvement in 6MWT distance, the AUC was 0.80 (95% CI: 0.74-0.86), with the same ≥3 steps/min threshold (sensitivity 0.75; specificity 0.77). These findings suggest that changes in walking cadence during usual-pace gait and the 6MWT may serve as a digitally measurable outcome to identify responders to mobility interventions. Further research is warranted to validate these findings in remote and real-world applications.

Skeletal muscle aging (sarcopenia) is associated with reduced peak oxygen consumption (VO peak) during exercise, a key determinant of physical function and overall health. However, the molecular mechanisms linking muscle aging to low VO peak remain poorly understood. We aimed to identify miRNA signatures and miRNA-gene regulatory networks associated with VO peak in older adults. Using small RNA and mRNA sequencing, we analyzed skeletal muscle from 72 SOMMA participants (70-79 years old) with low or high VO peak (n = 18/group) and from 36 participants spanning the full VO peak spectrum. Differential expression was assessed using LIMMA, with pathway and network analyses performed using Ingenuity Pathway Analysis (IPA) and Weighted Gene Co-expression Network Analysis (WGCNA). We detected 1,408 miRNAs and 16,210 genes; among these, 14 miRNAs and 2,018 genes were differentially expressed (FDR < 0.05). The 14 miRNAs regulated 142 genes, and expression of 10 miRNAs inversely correlated with 50 genes enriched in mitochondrial, sirtuin-1, and nitric oxide signaling pathways. Regression analyses identified 21 miRNAs and 1,744 genes significantly correlated with VO peak after adjusting for age and sex. WGCNA revealed 10 co-expression modules associated with VO peak, with the cyan module showing the strongest correlation and enrichment for nitric oxide signaling genes. These findings highlight novel miRNA-mediated molecular pathways potentially contributing to low VO peak and skeletal muscle aging in older adults. Future studies will further investigate these miRNA-gene interactions to uncover therapeutic targets for preserving muscle function with age.

BACKGROUND:Physical activity (PA) and inactivity have opposing associations with skeletal muscle function and are often studied separately but are codependent. We evaluated cross-sectional associations between 24-h time-use behaviors with muscle strength and power. METHODS:Sample included 751 community-dwelling older adults (76 ± 5 years, 57% women). Compositional data analysis determined 24-h proportions of time in moderate-to-vigorous PA (MVPA) and light intensity PA (LPA), inactivity, and sleep. Multiple linear regression by sex evaluated associations between 24-h composition with stair climb ascend and leg press power (W), and leg press (lbs) and grip strength (kg). Compositional isotemporal substitution quantified hypothetical reallocations of time between behaviors on power and strength. RESULTS:Compared to the average 24hr day in women (MVPA: 84 min/day, LPA: 349 min/day, inactivity: 559 min/day, sleep: 448 min/day), higher 24-h proportions of MVPA were associated with higher stair climb power (β: 16.2, 95% CI: 10.9, 21.4), leg press power (β: 23.7, 95% CI: 10.3, 37.2), and leg strength (β: 8.5, 95% CI: 2.4, 14.6); higher 24-h proportions of LPA were associated with lower stair climb power (β: -14.4, 95% CI: -25.8, -3.0); and higher 24-h proportions of inactivity were associated with higher grip strength (β: 2.3, 95% CI: 0.4, 4.3). Compositional isotemporal substitution found reallocating 10 min from LPA or inactivity to MVPA supported higher power and strength. No associations were observed in men. CONCLUSIONS:In women, not men, 24-h movement composition was associated with power and strength. MVPA interventions for power and strength improvements in women may be optimized when LPA or inactivity are reduced, not sleep.

BACKGROUND:Age-associated decline in mitochondrial oxidative capacity is associated with increased risk of disease, frailty, and disability. Oral nitrite and nitrate supplementation have been demonstrated to improve mitochondrial energetics and physical function in younger adults, but effects in older adults (age ≥70 years) remain unclear. METHODS:We conducted a randomized, placebo-controlled, double-blind, two-arm trial with a parallel group design to examine the effect of 20 mg sodium nitrite supplements administered three times a day for 12 weeks versus placebo in older (age ≥70 years) sedentary adults. Change in muscle mitochondrial respiration (complex I and II supported maximal oxidative phosphorylation [CI&II MaxOXPHOS]) was the primary outcome. Platelet bioenergetics, cardiorespiratory fitness, and other physical function measures were also assessed. RESULTS:Sixty-four adults (75.7 ± 5.7 years) completed the trial. Nitrite supplementation was not associated with improvements in skeletal muscle mitochondrial respiration, nor improvements in exercise capacity and physical function. However, platelet mitochondrial respiration changed significantly following an acute dose of oral nitrite. Notably, while nitrite levels increased 16- to 30-fold in plasma following an acute dose, levels increased only 1.6-fold in skeletal muscle. CONCLUSIONS:The divergent response of skeletal muscle versus platelet mitochondrial respiration in response to nitrite supplementation suggests tissue-specific pharmacokinetics and pharmacodynamics that likely impact the efficacy of nitrite supplementation. Results also suggest there may be age-related changes in drug delivery, metabolism, and mitochondrial responsiveness compared to the effects of nitrite/nitrate previously demonstrated in younger adults. Clinical Trial Registration Number: ClinicalTrials.gov NCT04405180.

OBJECTIVE:This study aimed to evaluate the impact of three lifestyle interventions on perceived physical fatigability. METHODS:Concurrent with a dietary weight loss program (caloric deficit ~400 kcal/day, weekly dietitian support), older adults with obesity (N = 183) were randomized to three groups: aerobic exercise (150-200 min/week of moderate-intensity treadmill walking; n = 60), daylong movement (improving daily activity distribution, progressively increase steps/day; n = 63), or combination (aerobic and daylong movement interventions; n = 60). Perceived physical fatigability (Pittsburgh Fatigability Scale [PFS] Physical score, range 0-50, and Rating of Perceived Exertion [RPE] after a 5-min 0% grade treadmill walk, range 6-20; higher = greater fatigability) was measured at baseline, 6 months (post-intensive intervention), and 18 months (end of maintenance period). RESULTS:Participants (69.6 ± 4.3 years, 77% female, 74% White, 35.6 ± 3.8 kg/m2 BMI) had a PFS Physical score 20.6 ± 7.6 and RPE Fatigability 9.6 ± 1.9 at baseline. Clinically relevant improvements were observed in PFS score from baseline to 6 months (-4.4 points, p = 0.002) and were largely maintained at 18 months (-3.0 points, p = 0.03) after adjustment for baseline age, sex, education, intervention group, and time × intervention group (p = 0.83). RPE Fatigability did not improve (p > 0.05). CONCLUSIONS:Multiple physical activity strategies in conjunction with weight loss improved perceived physical fatigability over time among older adults with obesity. TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT02923674.

Dopamine (DA) in the central nervous system is considered a master regulator of mobility performance and vigor, but its mechanistic relationship with skeletal muscle energetics is unclear. We tested the cross-sectional association of striatal DA and skeletal muscle mitochondrial function in 146 older adults participating in the Study of Muscle, Mobility and Aging (75.4 years old, 54% women). Striatal DA was measured using (+)-a-[11C] dihydrotetrabenazine (DTBZ) PET imaging for the limbic, sensorimotor, and executive control subregions. Mitochondrial capacity to produce ATP (ATPmax, mM ATP/s) was measured in vivo using 31P magnetic resonance spectroscopy after repeated voluntary muscle contractions. Ex-vivo respirometry assays from biopsies of resting muscle captured complementary aspects of mitochondrial function under optimal conditions. In multivariable linear regression models, [11C]DTBZ in the limbic striatum, but not other subregions, was positively associated with greater ATPmax in vivo, independent of demographics, muscle volume, leg power, white matter hyperintensities, gray matter atrophy, moderate-to-vigorous physical activity and diabetes (β = 0.275, standard error 0.108, p=0.019). [11C]DTBZ was not associated with the ex-vivo mitochondrial respiration markers (p>0.2). The role of striatal limbic DA and the energetic capacity of skeletal muscles should be further investigated in older adults.

Skeletal muscle aging (sarcopenia) is associated with reduced peak oxygen consumption (VO peak) during exercise, a key determinant of physical function and overall health. However, the molecular mechanisms linking muscle aging to low VO peak remain poorly understood. We aimed to identify miRNA signatures and miRNA–gene regulatory networks associated with VO peak in older adults. Using small RNA and mRNA sequencing, we analyzed skeletal muscle from 72 SOMMA participants (70–79 years old) with low or high VO peak (n = 18/group) and from 36 participants spanning the full VO peak spectrum. Differential expression was assessed using LIMMA, with pathway and network analyses performed using Ingenuity Pathway Analysis (IPA) and Weighted Gene Co-expression Network Analysis (WGCNA). We detected 1,408 miRNAs and 16,210 genes; among these, 14 miRNAs and 2,018 genes were differentially expressed (FDR < 0.05). The 14 miRNAs regulated 142 genes, and expression of 10 miRNAs inversely correlated with 50 genes enriched in mitochondrial, sirtuin-1, and nitric oxide signaling pathways. Regression analyses identified 21 miRNAs and 1,744 genes significantly correlated with VO peak after adjusting for age and sex. WGCNA revealed 10 co-expression modules associated with VO peak, with the cyan module showing the strongest correlation and enrichment for nitric oxide signaling genes. These findings highlight novel miRNA-mediated molecular pathways potentially contributing to low VO peak and skeletal muscle aging in older adults. Future studies will further investigate these miRNA–gene interactions to uncover therapeutic targets for preserving muscle function with age.

Musculoskeletal pain and mobility disability are common in older adults, but relationships among pain parameters and physical performance are poorly understood. We quantified the impact of different pain measures—recalled and movement-evoked pain—on walk and stair climb time in older adults from the Study of Muscle, Mobility and Aging (SOMMA). In SOMMA (N = 879, age = 76.3 ± 5.0 years, 59

The Reducing Inflammation for Greater Health Trial's (RIGHT) study is a single-center, randomized, double-blind, placebo-controlled trial designed to test whether clazkizumab, an interleukin-6 (IL-6) inhibitor, can improve or slow decline in physical, cognitive, and vascular function in older adults, when compared to a placebo. The trial will enroll participants meeting the following inclusion criteria: (1) ≥ 70 years of age, (2) with low to moderate physical function, defined as self-reported difficulty walking 1/4 mile or climbing a flight of stairs, but able to walk 400 m at baseline exam, (3) usual walking speed between ≥ 0.44 and < 1.0 m/s on a 4-m walk or a body mass index of ≥ 28 kg/m 2 , (4) average IL-6 level between 2.0 and 30 pg/mL on two tests, and (5) no active infection, cancer, or other serious health conditions. Clazakizumab, a monoclonal antibody targeting IL-6, 5 mg via subcutaneous injection every 4 weeks for 24 weeks compared to a placebo. The primary outcome will be walking speed over 400 m. Secondary outcomes include other measures of physical function (short physical performance battery, oxygen consumption with walking on a treadmill, fatigability), cognitive function, vascular stiffness and endothelial function, IL-6 and C-reactive protein levels, other markers of inflammation, safety, and tolerability. Findings will evaluate acceptability, safety and 6-months change in mobility and other outcomes. The study was approved by the IRB and is registered with ClinicalTrials.gov (NCT05727384). The RIGHT study will inform the geroscience hypothesis that modifying aging itself will lead to improvement in multiple aspects of health.

Time in moderate-to-vigorous intensity activity (MVPA), light intensity activity (LPA), and sleep are critical for bone health in older adults but are often considered separately despite being inherently co-dependent. We examined cross-sectional associations between compositions of accelerometry-derived MVPA, LPA, inactivity, and sleep with bone microarchitecture and strength (High-Resolution Peripheral Quantitative Computed Tomography; HR-pQCT) in community-dwelling older men (n=119) and women (n=177), mean age 76.3±4.6 yrs. Participants wore an ActiGraph GT9X on their non-dominant wrist for 7 consecutive 24hr periods during the Study of Muscle, Mobility and Aging (SOMMA) baseline visit. The primary outcomes were distal radius (DR) and tibia (DT) estimated failure load, and secondarily, total volumetric bone mineral density (vBMD), and cortical (Ct) and trabecular (Tb) vBMD, area (Ar), and thickness (Th) from HR-pQCT. Compositional data analysis methods evaluated proportions of time in one behavior relative to the remaining behaviors. Sex-stratified multiple linear regression estimated associations between 24hr composition with sex-specific standardized HR-pQCT parameters. Compositional isotemporal substitution methods estimated hypothetical changes in continuous HR-pQCT measures if 10-60 min in one behavior was displaced by another. On average, women spent 90.2 min/day (6.3%) in MVPA, 346.1 min/day (24.0%) in LPA, 556.4 min/day (38.6%) in inactivity, and 447.4 min/day (31.1%) in sleep; men spent 93.6 min/day (6.5%) in MVPA, 309.5 min/day (21.5%) in LPA, 596.7 min/day (41.4%) in inactivity, and 440.2 min/day (30.6%) in sleep. Compared to the average sex-specific 24hr composition, higher proportions of MVPA were associated with higher DR and DT failure load in women; higher DR Tb.vBMD and Tb.Th in men; and higher DR Tt.vBMD, Ct.Ar, and Ct.Th, and DT Ct.vBMD, Ct.Ar, and Ct.Th in women. Hypothetically displacing 10-60 min in inactivity for MVPA resulted in more favorable HR-pQCT parameters. These data support the importance of MVPA for a healthy skeleton in older men and women.

Promoting social connection among older adults is a public health priority. Addressing hearing loss may reduce social isolation and loneliness among older adults. To describe the effect of a best-practice hearing intervention vs health education control on social isolation and loneliness over a 3-year period in the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study. This secondary analysis of a multicenter randomized controlled trial with 3-year follow-up was completed in 2022 and conducted at 4 field sites in the US (Forsyth County, North Carolina; Jackson, Mississippi; Minneapolis, Minnesota; Washington County, Maryland). Data were analyzed in 2024. Participants included 977 adults (aged 70-84 years who had untreated hearing loss without substantial cognitive impairment) recruited from the Atherosclerosis Risk in Communities study (238 [24.4%]) and newly recruited (de novo; 739 [75.6%]). Participants were randomized (1:1) to hearing intervention or health education control and followed up every 6 months. Hearing intervention (4 sessions with certified study audiologist, hearing aids, counseling, and education) and health education control (4 sessions with a certified health educator on chronic disease, disability prevention). Social isolation (Cohen Social Network Index score) and loneliness (UCLA Loneliness Scale score) were exploratory outcomes measured at baseline and at 6 months and 1, 2, and 3 years postintervention. The intervention effect was estimated using a 2-level linear mixed-effects model under the intention-to-treat principle. Among the 977 participants, the mean (SD) age was 76.3 (4.0) years; 523 (53.5%) were female, 112 (11.5%) were Black, 858 (87.8%) were White, and 521 (53.4%) had a Bachelor’s degree or higher. The mean (SD) better-ear pure-tone average was 39.4 dB (6.9). Over 3 years, mean (SD) social network size reduced from 22.6 (11.1) to 21.3 (11.0) and 22.3 (10.2) to 19.8 (10.2) people over 2 weeks in the hearing intervention and health education control arms, respectively. In fully adjusted models, hearing intervention (vs health education control) reduced social isolation (social network size [difference, 1.05; 95% CI, 0.01-2.09], diversity [difference, 0.19; 95% CI, 0.02-0.36], embeddedness [difference, 0.27; 95% CI, 0.09-0.44], and reduced loneliness [difference, −0.94; 95% CI, −1.78 to −0.11]) over 3 years. Results were substantively unchanged in sensitivity analyses that incorporated models that were stratified by recruitment source, analyzed per protocol and complier average causal effect, or that varied covariate adjustment. This secondary analysis of a randomized clinical trial indicated that older adults with hearing loss retained 1 additional person in their social network relative to a health education control over 3 years. While statistically significant, it is unknown whether observed changes in social network are clinically meaningful, and loneliness measure changes do not represent clinically meaningful changes. Hearing intervention is a low-risk strategy that may help promote social connection among older adults. ClinicalTrials.gov Identifier: NCT03243422

Introduction:Preoperative physical functional assessments (i.e., assessments that measure capability to perform physical activity) are integral to estimate perioperative risk for older adults. However, these assessments are not routinely performed in-clinic prior to surgery. Walking cadence, or the number of steps walked in a specified amount of time (i.e., steps/min), measures activity intensity and may be able to identify high-risk patients prior to surgery. Smartphones can measure walking characteristics and guide patients through remote functional assessments. Here, we assess feasibility, acceptability, and accuracy of Walk Test, a smartphone application designed to measure walking cadence. Methods:We performed a prospective cohort study of older adults prior to abdominal surgery and enrolled them remotely to perform at-home usual- and fast-paced walks with subsequent validation in-clinic. Each walk (usual- and fast-paced) was 2 min in duration. Feasibility was assessed if 80% of patients could perform all study procedures; acceptability was measured using the Post-Study Survey Usability Questionnaire (PSSUQ); accuracy of our approach was assessed with Lin's concordance coefficient (CCC). activPAL thigh worn accelerometer worn during the in-clinic walk served as a gold standard comparison. We used the CCC to compare the at-home and in-clinic walks as performed by Walk Test. Results:We enrolled 41 participants (mean age 69 ± 5 years, 26 (63%) female); 88% (36/41) successfully completed entire study protocol including independent installation of the application, walk tests (at-home and in-clinic) and questionnaires. Median (interquartile range) overall score of PSSUQ was 1 (1, 1) indicating strong acceptability and usability. The Lin's CCC between the in-clinic activPAL and Walk Test for usual-paced walk was 0.97 (95% CI: 0.96, 0.99, p < 0.001) and for fast-paced walks 0.96 (95% CI: 0.93, 0.98, p < 0.001). The CCC between the at-home and in-clinic walks for usual-paced walks was 0.70 (95% CI: 0.53, 0.86) and for fast-paced walks was 0.46 (95% CI: 0.21, 0.72). Conclusion:We successfully demonstrated the feasibility, acceptability and accuracy of Walk Test to measure walking cadence. Future work is needed to standardize walk test performance at-home to ensure consistency between in-clinic and at-home measures.

BACKGROUND:Age-related hearing loss is common among older adults and may influence physical activity and sedentary behaviors, such as TV viewing. This study examined whether a hearing intervention could affect these behaviors over 3 years. METHODS:A total of 977 participants (mean age of 76.8, 53.5% female, 11.5% Black), recruited from the ARIC study (n = 238) and de novo (n = 739) with hearing loss (pure-tone average = 39.4 dB), were randomized to a hearing intervention or a health education control group. Physical activity, leisurely walking, and TV viewing were interrogated at baseline and 3-year follow-up. We used regression models adjusted for demographic and hearing loss severity to examine the impact of the intervention on the change in the frequency of engaging in these activities. RESULTS:At baseline, 57.6% of participants engaged in moderate-to-vigorous physical activity (MVPA), 29.1% in high-frequency leisurely walking, and 46.8% in high-frequency TV viewing. Over 3 years, MVPA decreased to 48.8%, whereas leisurely walking and TV viewing increased. After 3 years, the hearing intervention group had similar odds of engaging in MVPA (ratio of odds ratios [ROR] = 1.03, 95% confidence interval [CI], 0.93-1.14), leisurely walking (ROR = 1.04, 95% CI, 0.93-1.17), and TV viewing (ROR = 0.95, 95% CI, 0.87-1.02) compared with the control group. Results were consistent across recruitment sources (ARIC and de novo). CONCLUSION:A hearing intervention did not significantly influence physical activity, walking, or TV viewing behaviors in older adults over 3 years. Additional strategies may be needed to change physical and sedentary behaviors in this population.

Background: Fatigue and fatigability are commonly reported in spinal muscular atrophy (SMA). Physical fatigability, proposed to be the most relevant to SMA pathophysiology, encompasses performance-based and perceived physical fatigability (PPF) assessments. While performance-based measures have highlighted physical fatigability as an SMA hallmark, PPF is not well characterized due to the lack of disease- and construct-specific scales. Objective: Our aim was to create a patient-reported outcome measure tailored for SMA, named the SMA EFFORT, to improve PPF assessment. Here, we describe the scale development process, assess scale properties, and discuss future research and application. Methods: SMA and scale development experts organized a comprehensive physical activity item bank, relevant across the SMA phenotypic spectrum. Activities were systematically categorized by varying intensities and durations. The SMA EFFORT was completed by an international cohort of individuals with all types of SMA. To compare PPF across demographic and clinical variables, SMA EFFORT PPF percent (PPF%) composite scoring was established. Results: One hundred eighteen participants completed the SMA EFFORT. Total PPF% scores were broadly distributed within functional groups, with differences between non-sitters (35.1 ± 21.0) and sitters (24.9 ± 15.1) ( p = 0.006), and those with (34.4 ± 18.1) and without respiratory support (26.4 ± 17.8) ( p = 0.02). Participants treated with disease modifying therapy (DMT) showed similar scores to those without treatment ( p = 0.70). Further, no differences in scores were observed in participants with scoliosis surgery and those without ( p = 0.71). Subscale analyses revealed differences in mean PPF% subscale scores by functional group. Conclusions: The novel SMA EFFORT standardizes PPF ratings by anchoring activity to intensity and duration. Item and scale data insights will inform the next iteration, which will undergo additional investigation. The SMA EFFORT aims to improve upon current measures to better assess treatment impact on physical well-being across the SMA spectrum.

Prior longitudinal studies among older adults have documented associations between hearing loss and changes in brain morphology. Whether interventions involving hearing aids can reduce age-related atrophy is unknown. A substudy within the Aging and Cognitive Health Evaluation in Elders (ACHIEVE, Clinicaltrials.gov Identifier: NCT03243422) randomized controlled trial tested the effect of a best-practices hearing intervention versus health education control on three-year change in cortical thickness among older adults with hearing loss. The ACHIEVE study enrolled 977 community-dwelling adults aged 70-84 years at baseline (2018-2019) with untreated hearing loss (better ear pure tone average [0.5-4 kHz] ≥30 and <70 dB HL) and without substantial cognitive impairment from four sites across the U.S. (Jackson, MS, Forsyth County, NC, Minneapolis, MN, Washington County, MD). Participants were randomized to a hearing intervention (provision of hearing aids and related technologies, counseling, and education) or a health education control (individual sessions with a health educator covering topics relevant to chronic disease and disability prevention). Three-dimensional magnetic resonance imaging was performed on 3 Tesla Siemens scanners in a subsample of 445 participants at the ACHIEVE baseline and three-year follow-up. Linear mixed effects models were used in intention-to-treat analyses to estimate three-year change in cortical thickness. All models adjusted for baseline measures of hearing loss, recruitment source, site, age, sex, and education. Missing outcome and covariate data was imputed to mitigate bias caused by informative attrition. At baseline, 224 participants were women (50.3%), 52 participants were Black (11.7%), and the mean (SD) age was 76.4 (4.0) years old (Table 1). Compared to the health education control, the hearing intervention exhibited a nominally protective effect on three-year change in average cortical thickness (Figure 1). The greatest effect size for cortical thickness was observed in the occipital lobe, while the smallest effect size was detected in the temporal lobe. Statistically significant effects were detected in the pars orbitalis, rostral anterior cingulate, posterior cingulate, and isthmus cingulate (Figure 2). Hearing aid use may reduce decline in cortical thickness among older adults. The effects of hearing aids may be greatest in regions other than those associated with the auditory cortex.

The Pittsburgh Fatigability Scale (PFS) was developed to assess perceived physical and mental fatigability in older adults (≥ 60 years). No perceived fatigability questionnaire has been validated to date for use among the Arabic older adult population. The aim of this study was to translate the PFS into Arabic language, and to assess the reliability and validity of the translated version among an Arabic older adult population. The primary design of this methodological study was cross-sectional. The PFS was translated into Arabic using the forward-backward translation method according to established guidelines. Internal consistency was evaluated by Cronbach’s alpha coefficient. The test-retest reliability was evaluated using intraclass correlation coefficients over a two-week interval. Construct validity was evaluated by exploratory and confirmatory factor analyses. The convergent and discriminant validity were measured by calculating Spearman’s correlation coefficients between the PFS– Arabic version and the Arabic versions of the Fatigue Severity Scale (FSS), Perceived Stress Scale (PSS), and WHO-5 Well-Being Index. The validity and reliability sample included 277 older adults with a mean age of 66.0 ± 5.3. For the PFS– Arabic version, the intraclass correlation coefficient for test-retest reliability for both the physical and mental subscale was high (0.97). Cronbach’s alpha for the PFS– Arabic version was 0.75 for the physical fatigability subscale and 0.71 for the mental fatigability subscale. The results of the factor analyses revealed that a four-factor model of PFS– Arabic version physical and mental subscales was a good model fit in our sample. Both subscales of PFS– Arabic version showed moderate correlation with FSS (r = 0.3, p < 0.0001) and weak correlation with PSS (r = 0.2). The WHO-5 showed a moderate correlation with PFS– Arabic Physical subscale (r = -0.3) and weak correlation with PFS– Arabic Mental subscale (r = -0.2). The PFS– Arabic version showed good psychometric properties and is recommended for use among Arabic-speaking populations to assess perceived fatigability in older adults.

Background: Reduced functional capacity (FC) is associated with adverse surgical outcomes in older adults. Current FC assessments rely on questionnaires; however, it remains unclear whether accelerometer-measured daily activity provides a more accurate evaluation. Our primary aim was to identify accelerometer-based variables associated with reduced FC. Methods: We conducted a secondary analysis of the Study of Muscle, Mobility and Aging (SOMMA) cohort. Participants were community-dwelling adults (non-surgical) aged ≥70 yr and recruited between the years 2019 to 2021 at the University of Pittsburgh (Pittsburgh, PA, USA) and Wake Forest University School of Medicine (Winston-Salem, NC, USA). Participants were included if they completed cardiopulmonary exercise testing and had valid wear time (≥3 days) for two accelerometers used in the SOMMA study (ActiGraph GT9X and activPAL4). We applied classification and regression tree and random forest models to accelerometry-derived metrics. For comparison, we constructed a logistic regression model using modified Duke Activity Status Index 4-Question (M-DASI-4Q) scores extrapolated from the Community Healthy Activities Model Program for Seniors questionnaire. Results: The final cohort included 640 participants (57.2% [366/640] women; mean age 76.3 [5.0] yr), of whom 18% (114/640) had reduced FC (peak oxygen uptake [VO2peak] <16 ml kg−1 min−1). Participants with adequate FC had higher daily step counts (5843.9 [2950.4] vs 2988.3 [1757.2] steps per day; P<0.001) and more time in moderate-to-vigorous physical activity (118.0 [62.2] vs 59.9 [42.4] min day−1; P<0.001) compared with those with reduced FC. The accelerometer-based random forest model (AUC 0.79) did not significantly outperform the M-DASI-4Q model (AUC 0.72; P=0.16). Conclusion: Among community-dwelling older adults, daily step count and time in moderate-to-vigorous activity were most associated with FC, but the accelerometer-based model showed only fair discrimination to identify participants with reduced FC. Validation in surgical populations is needed.

PURPOSE:It is recognized that disruptions in circadian behavior, such as with shift work or jet lag, are associated with diminished health. This known relationship implies that people with stronger indices of circadian behavior will exhibit improved physiology. To address the association between rhythmic activity behavior and physiology, we proposed that metrics indicative of "more rhythmic" rest-activity patterns would be associated with better cardiorespiratory fitness and walking energetics in a cohort of older adults. METHODS:Using baseline data from the Study of Muscle, Mobility and Aging ( N = 799, age: 76 ± 5 yr, 58% female), we quantified metrics describing rhythmic aspects of rest-activity behavior (amplitude, robustness, time of peak activity, others) from continuous wrist-worn accelerometry. We used linear models to examine cross-sectional associations between rhythmic metrics with V̇O 2peak and walking energetics (cost-capacity ratio at slow and preferred walking speeds) adjusted for age, sex, race, height, health conditions, and other factors. RESULTS:Metrics that reflect more rhythmic behavior were associated with V̇O 2peak (higher amplitude: Q1: 18.4 vs Q4: 22.0 mL·kg -1 ·min -1 ; P -trend < 0.001) higher pseudo- F statistic/robustness (Q1: 19.2 vs Q4: 21.3 mL·kg -1 ·min -1 ; P -trend < 0.001), and earlier time of peak activity (Q1 (earliest): 20.9 vs Q4 (latest): 19.2 mL·kg -1 ·min -1 ; P -trend < 0.001). Similar trends were observed with lower cost-capacity ratio at preferred and slow walking speeds (amplitude, pseudo- F statistic, acrophase: P -trend < 0.001 for all). CONCLUSIONS:More rhythmic activity behavior and earlier time of peak activity were associated with better cardiorespiratory fitness and walking energetics. These findings support the framework that rhythmic activity supports healthy physiology. Further investigations are warranted to determine if declines in rhythmicity of human behavior are predictive of disease.