Background Sarcopenia is a serious public health concern among older adults worldwide. Exercise is the most common intervention for sarcopenia. This study aimed to compare the effectiveness of different exercise types for older adults with sarcopenia. Methods Randomized controlled trials (RCTs) that examined the effectiveness of exercise interventions on patient-important outcomes for older adults with sarcopenia were eligible. We systematically searched MEDLINE, Embase and Cochrane Central Register of Controlled Trials via Ovid until 3 June 2022. We used frequentist random-effects network meta-analyses to summarize the evidence and applied the Grading of Recommendations, Assessment, Development, and Evaluations framework to rate the certainty of evidence. Results Our search identified 5988 citations, of which 42 RCTs proved eligible with 3728 participants with sarcopenia (median age: 72.9 years, female: 73.3%) with a median follow-up of 12 weeks. We are interested in patient-important outcomes that include mortality, quality of life, muscle strength and physical function measures. High or moderate certainty evidence suggested that resistance exercise with or without nutrition and the combination of resistance exercise with aerobic and balance training were the most effective interventions for improving quality of life compared to usual care (standardized mean difference from 0.68 to 1.11). Moderate certainty evidence showed that resistance and balance exercise plus nutrition (mean difference [MD]: 4.19 kg) was the most effective for improving handgrip strength (minimally important difference [MID]: 5 kg). Resistance and balance exercise with or without nutrition (MD: 0.16 m/s, moderate) were the most effective for improving physical function measured by usual gait speed (MID: 0.1 m/s). Moderate certainty evidence showed that resistance and balance exercise (MD: 1.85 s) was intermediately effective for improving physical function measured by timed up and go test (MID: 2.1 s). High certainty evidence showed that resistance and aerobic, or resistance and balance, or resistance and aerobic exercise plus nutrition (MD from 1.72 to 2.28 s) were intermediately effective for improving physical function measured by the five-repetition chair stand test (MID: 2.3 s). Conclusions In older adults with sarcopenia, high or moderate certainty evidence showed that resistance exercise with or without nutrition and the combination of resistance exercise with aerobic and balance training were the most effective interventions for improving quality of life. Adding nutritional interventions to exercise had a larger effect on handgrip strength than exercise alone while showing a similar effect on other physical function measures.

The present article outlines the development and implementation of a multifaceted psychological skills training program for the Canadian National Short Track Speedskating team over a 3-year period leading up to the Vancouver 2010 Olympic Games. A program approach was used emphasizing a seven-phase model in an effort to enhance sport performance (Thomas, 1990) in which psychological skills training was integrated with biofeedback training to optimize self-regulation for performance on demand and under pressure. The biofeedback training protocols were adapted from general guidelines described by Wilson, Peper, and Moss (2006) who built on the work of DeMichelis (2007) and the “Mind Room” program approach for enhancing athletic performance. The goal of the program was to prepare the athletes for their best performance under the pressure of the Olympic Games. While causation cannot be implied due to the lack of a control group, the team demonstrated success on both team and individual levels.

As part of a larger training program, applying a new biofeedback protocol for improving reaction time (RT) performance among elite speed skaters at the Canadian Speedskating National Training Center in Montreal, Canada, provided an advantage at the Vancouver 2010 Olympic Games, allowing athletes to assert themselves and claim the best starting position during the event. Each athlete participated in a twice-weekly biofeedback RT training for 5 weeks, for a total of 600 RT practice trials, simulating speed-skating activities such as reacting to commands of ''go to the start,'' ''ready,'' and the sound of a signal from a gun to start. There was an overall improvement in RT performance from the beginning to the end of the 5-week period, with the largest improvement occurring between Weeks 4 and 5 of the training, F(1, 9) 5 679.2, p 5 .001. The results suggest that biofeedback protocols will become an essential part of a winning strategy for future interventions in speed skater training.

Objectives: Risk prediction scores are important tools to support clinical decision-making for patients with coronavirus disease (COVID-19). The objective of this paper was to validate the 4C mortality score, originally developed in the United Kingdom, for a Canadian population. Methods: We conducted an external validation study within a registry of COVID-19 positive emergency department visits and hospital admissions in the Kitchener-Waterloo and Hamilton regions of southern Ontario between March 4 and January 9, 2020. We examined the validity of the 4C score to prognosticate in-hospital mortality using the area under the receiver operating characteristic curve (AUC) with 95% confidence intervals calculated via bootstrapping. Results: The study included 560 individuals, of whom 115 (20.5%) died in-hospital. Median age was 69 years and 281 individuals (51%) were male. The AUC of the 4C score was 0.83, 95% confidence interval 0.79-0.87. Mortality rates across the pre-defined risk groups were 0% (Low), 3.2% (Intermediate), 25.9% (High), and 59.5% (Very High). The AUC was 0.80 (0.76-0.85) among hospital inpatients. Interpretation: The 4C score is a valid tool to prognosticate mortality from COVID-19 in Canadian emergency departments and hospitals.

Background decreased muscle strength and physical function often precede disability, nursing home admission, home care use and mortality in older adults. Normative values for commonly used physical performance-based tests are not widely available for older adults but are required for clinicians and researchers to easily identify individuals with low performance. Objective to develop normative values for grip strength, gait speed, timed up and go, single-leg balance and five-repetition chair rise tests in a large population-based sample of Canadians aged 45–85 years. Methods baseline data (2011–2015) from the Canadian Longitudinal Study on Ageing was used to estimate age- and sex-specific normative values for each of the physical tests. Participants were without disability or mobility limitation (no assistance with activities of daily living or use of mobility devices). Results of the 25,470 participants eligible for the analyses 48.6% (n = 12,369) were female with a mean age of 58.6 ± 9.5 years. Sex-specific 5th, 10th, 20th, 50th, 80th, 90th and 95th percentile values for each physical performance-based test were estimated. Cross-validation (n = 100 repetitions) with a 30% holdout sample was used to evaluate model fit. Conclusions the normative values developed in this paper can be used in clinical and research settings to identify individuals with low performance relative to their peers of the same age and sex. Interventions targeting these at-risk individuals including physical activity can prevent or delay mobility disability and the resulting cascade of increasing care requirements, health care costs and mortality.