The small sample does not allow for conclusions, but we can suggest that inspiratory muscular training improves insulin sensitivity in elderly patients with insulin resistance.

Fasting hyperglycemia is often observed in the older adult population, showing that after the age of 50, fasting blood glucose levels increase by 0.06 mmol/decade. Therefore, many authors embrace the hypothesis that with aging and progressive fasting blood sugar disorders can lead to glucose intolerance and type 2 diabetes.1 Fasting hyperglycemia (100-125 mg/dl or 5.6 to 6.9 mmol/L) is defined as an intermediate state type 2 diabetes and normal levels. Older people are often faced with limitations when it comes to regular physical activity, in these cases, inspiratory muscle training with Threshold® can be an effective alternative to overcome these barriers. A study carried out in older adult with insulin resistance revealed significant improvements after inspiratory training with the Threshold device. These results support the use of intervention in fasting hyperglycemia. 3For this research, 38 older adults over 60 years with fasting hyperglycemia from the Center for the Study of Aging at UNIFESP were divided into 2 groups: a control group (n = 20) that trained with the Threshold device with minimal load and an experimental group (n = 18) that performed respiratory muscular training during the first session of each week at inspiratory loads of 40% of the maximal inspiratory pressure (PImax). The training program was performed over 8 weeks in 30-minute daily sessions.Data were analyzed and the comparison between groups was done using SPSS version 19.0, and means were analyzed using ANOVA.The 2 groups were homogeneous, showing a mean age of 74.10 years, BMI of 27 kg/m 2 . After intervention, the individuals presented a significant increase of the inspiratory and expiratory pressure values, maximum threshold pressure sustained, and charging times in both groups. The laboratory evaluation results showed the interaction effects for blood glucose variable and HOMA-β. Others variables presented no significant differences and remained within the normal range (see Table 1).Intervention increased inspiratory and expiratory pressure values, and the result was expected to the extent that the recruitment of motor units promoted increased muscle strength in muscles working in the thoracoabdominal region. 4 Inspiratory muscle training induced a reduction in fasting glucose levels and improved the secretory capacity of pancreatic β cells. These results support a previous study in which inspiratory muscle training effectively improved insulin resistance, where the respiratory training may strengthen the skeletal musculature improving diaphragmatic respiratory capacity and increasing mobilization of GLUT4 with subsequent increase in glucose uptake and a reduction in HOMA-IR parameters.3 Another hypothesis is that the reduction of impaired fasting glucose in the older adult population may be due to an improvement in mitochondrial oxidative metabolism and a decreased reactive oxygen species (ROS) production, increased antioxidant capacity, or increased mitochondrial density.5 Moreover, the mitochondrial theory of aging proposes th...

Aging is accompanied by changes in the quantity and quality of sleep. Obstructive sleep apnea (OSA) is also more prevalent in the older population. Although severe OSA has been linked to a higher risk of cardiovascular disease regardless of adult age, clinical consequences of mild-to-moderate OSA in the older adults are still uncertain.ObjectivesTo investigate the relationships between severity and metabolic, cognitive, and functional characteristics in community-dwelling older adults from a representative sample of the city of São Paulo.MethodsIn total, 199 participants of the first follow-up of the São Paulo Epidemiologic Sleep Study (EPISONO, São Paulo, Brazil) >60 years were cross-sectionally assessed through questionnaires, physical evaluations, laboratory tests, and full in-lab polysomnography (PSG). Three groups according to the OSA severity were compared according to sociodemographic characteristics, anthropometric measures, PSG parameters, the frequency of comorbidities, and the use of medications.ResultsParticipants' age ranged from 60 to 87 years with a mean of 70.02 ± 7.31, 59.8% female. In the univariate analysis, body mass index (BMI, kg/m2) (p = 0.049) and waist circumference (p = 0.005) were significantly higher in the participants with moderate OSA, but not among those with severe OSA. Participants with severe OSA had a higher arousal index (p = 0.007). Multivariate analysis showed that severe OSA was significantly associated with hypertension (p = 0.005), heart diseases (p = 0.025), and the use of two or more medications (p = 0.035).ConclusionIn a population-based study, severe, but not mild-to-moderate, OSA in older adults was associated with hypertension and the use of more medications. As age advances, anthropometric indicators of obesity may not increase the risk of severe OSA.

Abbreviations: (HRV) heart rate variability, (LF) low frequency Keywords: aging, insulin resistance, heart rate variability, respiratory training aging, insulin resistance, heart rate variability, respiratory training St udies have shown that physiological aging is accompanied by insulin resistance and reduction in heart rate variability (HRV) because of decreased vagal activity at the sinus node, decreased baroreflex activity, and increased sympathetic activity, resulting in reduced complexity of regulatory systems. 1The inspiratory muscle training reduces sympathetic activity, improves inspiratory muscle function, and increases the glucose transport within the musculature of the diaphragm. 2,3For this research, 21 insulin-resistant elderly patients were recruited on the basis of their results on testing with the homeostasis model assessment of insulin resistance. Variability in heart rate was evaluated while the patient was lying down resting for 10 min on a stretcher. The data were acquired using a Polar S810i ® frequency meter (Polar Inc., Kempele, Finland).The subjects were divided into two groups: a control group, which was trained using no Threshold ® load, and an experimental group, which underwent respiratory muscle training using a Threshold load, with 40% of inspiratory pressure reached during the first session of each week. The program lasted 12 weeks, and both groups trained daily for 30 min.Due to the small sample size, differences between the groups were tested using the Wilcoxon rank sum test.A comparison of both the clinical and laboratory characteristics of the groups before and after treatment showed values of glucose, insulin, and homeostasis model assessment of insulin resistance changed. Respiratory exercise resulted in an increase in the standard deviation of NN intervals and in coefficient of variation in the experimental group. The absolute low-frequency (LF) component decreased in the experimental group. Further, the normalized LF component of HRV was lower in the experimental group. The normalized high-frequency component increased in the experimental group. Consequently, respiratory exercise promoted a decrease in sympathovagal balance in the experimental group. A positive correlation was found between insulin and sympathetic modulation (LF% r = 0.34, p = .03), and abdominal circumference showed a positive correlation with LF% (r = 0.53, p = .006; Figure 1).The major finding of this study was that inspiratory muscle training increased HRV and decreased sympathetic modulation in elderly patients with insulin resistance, without changing the respiratory frequency, through strengthening of the inspiratory muscles.

Background and aimsAging is a multifactorial process that elicits changes in the duration and quality of sleep. Polysomnography is considered to be the standard examination for the analysis of sleep and consists of the simultaneous recording of selected physiological variables during sleep.ObjectiveThe objective of this study was to use polysomnography to compare sleep reported by senior citizens.MethodsWe selected 40 patients, both male and female, with ages ranging from 64 to 89 years from the Center for the Study of Aging at the Federal University of São Paulo. Patients answered questions about sleep on the Comprehensive Geriatric Assessment and underwent polysomnography.ResultsThe results were compared, and agreement between perceived sleep and polysomnography was found in several areas. There was an association between difficulty sleeping and sleep onset latency (p=0.015), waking up at night with sleep onset latency (p=0.005), total sleep time with daytime sleepiness (0.005) and snoring (0.027), sleep efficiency with sleepiness (0.004), snoring (0.033) and pause in breathing (p=0.024), awakenings with snoring (p=0.012) and sleep apnea with pauses in breathing (p=0.001).ConclusionThese results suggest that the older adult population have a good perception of their sleep. The questionnaires aimed at this population should be used as an alternative to polysomnography.