One of the most widely conserved hallmarks of aging is a decline in functional capabilities. Mobility loss is particularly burdensome due to its association with negative health outcomes, loss of independence and disability, and the heavy impact on quality of life. Recently, a new condition, physical frailty and sarcopenia, has been proposed to define a critical stage in the disabling cascade. Physical frailty and sarcopenia are characterized by weakness, slowness, and reduced muscle mass, yet with preserved ability to move independently. One of the strategies that have shown some benefits in combatting mobility loss and its consequences for older adults is physical activity. Here, we describe the opportunities and challenges for the development of physical activity interventions in people with physical frailty and sarcopenia. The aim of this article is to review age-related physio(patho)logical changes that impact mobility in old age and to provide recommendations and procedures in accordance with the available literature.

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The trace elements Ba, Bi, Cd, Co, Cs, Cu, Hg, La, Mn, Mo, Pb, Rb, Sb, Sn, Sr, Tl, and Zn were determined by inductively coupled plasma mass spectrometry in plasma samples of 68 hemodialysis patients. The same elements (with exception of La and Mn) were also determined in whole blood after mineralization with high-purity nitric acid/hydrogen peroxide in a closed-pressurized microwave system. The accuracy and precision was checked by analyzing two Seronorm "whole blood" reference materials. All samples were contaminated with barium (heparinized tubes) and the plasma samples with tin (collection tubes). The concentrations for Bi, Hg, Pb, Rb, Sb, and Sr in whole blood were within the literature ranges for healthy adults. All of the concentrations for Co, and some of the concentrations for Cd, Cs, Tl, and Zn were higher than the high limits of the normal ranges. Approximately 14% of the Cu concentrations were lower than the low limit of the normal range. The Mo and Sn concentrations are difficult to evaluate, because the normal ranges appears to be unreliable. All concentrations for Cd, Co, Mo, Pb, Sn, and Sr and some of the concentrations for Cu (15%) and Mn (75%) in the plasma samples were higher than the high limits of the normal ranges. The concentrations for Rb tended to be lower than the normal range. To establish unequivocally the causes for elevated and reduced concentrations of trace elements in whole blood and plasma of dialysis patients, all fluids in the dialysis process must be investigated.

Recent studies have indicated a link between bone metabolism and cardiovascular events in patients with chronic kidney disease (CKD). CKD is a major health problem worldwide. This study evaluates the role of noninvasive markers of bone metabolism in predicting cardiovascular morbidity (coronary artery disease, peripheral vascular disease, stroke) and mortality in patients with mild to severe forms of CKD. In a prospective cohort study, 627 patients with CKD were screened. To focus on bone metabolism, traditional risk factors for cardiovascular events were excluded, and 135 patients with CKD stages 1-5 were followed for 4 yr. Glomerular filtration rate was calculated by the Modification of Diet in Renal Disease formula. PTH (measured by four different assays), vitamin D 25 and 1,25, bone-specific alkaline phosphatase (BSALP), TRACP5b, osteocalcin, serum collagen cross-link molecules, RANKL, and osteoprotegerin were determined. Predictors of cardiovascular events were evaluated by multivariable logistic regression, Kaplan-Meier survival, and Cox regression analysis. There were a total of 45 cardiovascular events (33%). Event rates were 5.6%, 29.1%, 45.2%, and 45.0% in CKD stages 1-2, 3, 4, and 5, respectively. In logistic regression, cardiovascular events were predicted only by (1) CKD stage (independent of age or sex; p < 0.001); (2) BSALP (p ‫ס‬ 0.03); and (3) TRACP-5b (p ‫ס‬ 0.04). Markers of bone formation (BSALP) and resorption (TRACP-5b) can serve as predictors of cardiovascular morbidity and mortality in CKD.

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