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Maren S. Fragala

Bio: Maren S. Fragala is an academic researcher from Quest Diagnostics. The author has contributed to research in topics: Sarcopenia & Medicine. The author has an hindex of 43, co-authored 157 publications receiving 7338 citations. Previous affiliations of Maren S. Fragala include University of Massachusetts Amherst & Johns Hopkins University School of Medicine.


Papers
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Journal ArticleDOI
TL;DR: Based on the analyses presented in this series, the final recommended cutpoints for weakness are grip strength <26kg for men and <16kg for women, and for low lean mass, appendicular lean mass adjusted for body mass index <0.789 forMen and women.
Abstract: Background. Low muscle mass and weakness are common and potentially disabling in older adults, but in order to become recognized as a clinical condition, criteria for diagnosis should be based on clinically relevant thresholds and independently validated. The Foundation for the National Institutes of Health Biomarkers Consortium Sarcopenia Project used an evidence-based approach to develop these criteria. Initial findings were presented at a conference in May 2012, which generated recommendations that guided additional analyses to determine final recommended criteria. Details of the Project and its findings are presented in four accompanying manuscripts.

1,542 citations

Journal ArticleDOI
TL;DR: Evidence is provided to support recommendations for successful resistance training in older adults related to 4 parts: program design variables, physiological adaptations, functional benefits, and considerations for frailty, sarcopenia, and other chronic conditions.
Abstract: Fragala, MS, Cadore, EL, Dorgo, S, Izquierdo, M, Kraemer, WJ, Peterson, MD, and Ryan, ED. Resistance training for older adults: position statement from the national strength and conditioning association. J Strength Cond Res 33(8): 2019-2052, 2019-Aging, even in the absence of chronic disease, is associated with a variety of biological changes that can contribute to decreases in skeletal muscle mass, strength, and function. Such losses decrease physiologic resilience and increase vulnerability to catastrophic events. As such, strategies for both prevention and treatment are necessary for the health and well-being of older adults. The purpose of this Position Statement is to provide an overview of the current and relevant literature and provide evidence-based recommendations for resistance training for older adults. As presented in this Position Statement, current research has demonstrated that countering muscle disuse through resistance training is a powerful intervention to combat the loss of muscle strength and muscle mass, physiological vulnerability, and their debilitating consequences on physical functioning, mobility, independence, chronic disease management, psychological well-being, quality of life, and healthy life expectancy. This Position Statement provides evidence to support recommendations for successful resistance training in older adults related to 4 parts: (a) program design variables, (b) physiological adaptations, (c) functional benefits, and (d) considerations for frailty, sarcopenia, and other chronic conditions. The goal of this Position Statement is to a) help foster a more unified and holistic approach to resistance training for older adults, b) promote the health and functional benefits of resistance training for older adults, and c) prevent or minimize fears and other barriers to implementation of resistance training programs for older adults.

505 citations

Journal ArticleDOI
TL;DR: Cutpoints for weakness derived from this large, diverse sample of older adults may be useful to identify populations who may benefit from interventions to improve muscle strength and function.
Abstract: Muscle weakness is related to poor physical performance and incident mobility limitations among older adults (1–6). Weakness is considered a key element of frailty (7) and, increasingly, of sarcopenia (8,9). Although the association between weakness and functional limitations is strong, there is no consensus regarding a cutpoint for identification of risk for functional problems. In order to identify population subgroups in whom weakness is a potential contributor to functional limitations, it is necessary to determine what constitutes a clinically relevant degree of weakness. This is the second in a series of reports from the Foundation for the National Institutes of Health (FNIH) Sarcopenia Project, which pooled data from multiple studies to develop and evaluate clinically relevant criteria for weakness and low muscle mass (10). The purpose of the analysis presented here was to identify cutpoints that distinguish weakness (measured by grip strength) associated with mobility impairment (measured by gait speed) using cross-sectional data (ie, to maximize concurrent validity). This analysis builds on previous research on the association between strength and walking speed using a data-driven approach across multiple populations and an analytic technique (Classification and Regression Tree [CART] analysis) designed to optimize concurrent validity in the context of complex interactions. Findings were used to address subsequent Project goals reported separately (11–13).

391 citations

Journal ArticleDOI
TL;DR: Findings support the cut-points for low grip strength and low ALM-to-BMI ratio as candidate criteria for clinically relevant weakness and low lean mass and further validation in other populations and for alternate relevant outcomes is needed.
Abstract: Results. Low grip strength (men: odds ratio (OR) = 2.31, 95% confidence interval (CI) = 1.34-3.99; women: OR = 1.99, 95% CI 1.23-3.21), low grip strength-to-BMI ratio (men: OR = 3.28, 95% CI 1.92-5.59; women: OR = 2.54, 95% CI 1.10-5.83) and low ALM-to-BMI ratio (men: OR = 1.58, 95% CI 1.12-2.25; women: OR = 1.81, 95% CI 1.14-2.87), but not low ALM, were associated with increased likelihood for incident mobility impairment. Weakness increased likelihood of mobility impairment regardless of low lean mass. Mortality risk patterns were inconsistent. Conclusions. These findings support our cut-points for low grip strength and low ALM-to-BMI ratio as candidate criteria for clinically relevant weakness and low lean mass. Further validation in other populations and for alternate relevant outcomes is needed.

346 citations

Journal ArticleDOI
TL;DR: The FNIH criteria result in a more conservative operational definition of sarcopenia, and the prevalence was lower compared with other proposed criteria, including the International Working Group and the European Working Group for Sarcopenia in Older Persons.
Abstract: Low muscle mass and weakness are potential contributors to disability in older persons. Although the term “sarcopenia” has become widespread, the criteria for an operational definition vary among studies and experts. Initial work on defining sarcopenia was based on measures of muscle mass alone, and the prevalence of sarcopenia when compared with a young reference population ranged between 13% and 24% among adults younger than 70 years to more than 50% among adults older than 80 years (1). However, a growing body of research suggests that there is a disconnect between muscle mass and strength. Thus, recent definitions of sarcopenia have incorporated elements of strength and physical performance in addition to muscle mass in the criteria for sarcopenia (2–5). However, these consensus statements were based on expert opinions and lacked access to large data sets to validate their recommendations. Thus, the goal of the Foundation for the National Institutes of Health (FNIH) Sarcopenia Project was to create a data-driven set of criteria for clinically relevant weakness and low lean mass using pooled data from multiple studies. This is the fifth report of the FNIH Sarcopenia Project. The first manuscript describes the rationale for the FNIH Sarcopenia Project and characteristics of the participating studies. The second and third manuscripts describe in detail the development of cutpoints for weakness and low lean mass; and the fourth manuscript demonstrates the predictive validity of these cutpoints. The purpose of the analyses presented here is to compare the criteria developed by the FNIH project to other published criteria, in order to assess prevalence, agreement, and discrepancies between candidate criteria. Our goal is to provide data-driven evidence to the field in order to advance professional consensus regarding clinically relevant cutpoints and terminology.

319 citations


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Journal ArticleDOI
TL;DR: An emphasis is placed on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarc Openia diagnosis, and provides clear cut-off points for measurements of variables that identify and characterise sarc openia.
Abstract: Background in 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a sarcopenia definition that aimed to foster advances in identifying and caring for people with sarcopenia. In early 2018, the Working Group met again (EWGSOP2) to update the original definition in order to reflect scientific and clinical evidence that has built over the last decade. This paper presents our updated findings. Objectives to increase consistency of research design, clinical diagnoses and ultimately, care for people with sarcopenia. Recommendations sarcopenia is a muscle disease (muscle failure) rooted in adverse muscle changes that accrue across a lifetime; sarcopenia is common among adults of older age but can also occur earlier in life. In this updated consensus paper on sarcopenia, EWGSOP2: (1) focuses on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarcopenia diagnosis, and identifies poor physical performance as indicative of severe sarcopenia; (2) updates the clinical algorithm that can be used for sarcopenia case-finding, diagnosis and confirmation, and severity determination and (3) provides clear cut-off points for measurements of variables that identify and characterise sarcopenia. Conclusions EWGSOP2's updated recommendations aim to increase awareness of sarcopenia and its risk. With these new recommendations, EWGSOP2 calls for healthcare professionals who treat patients at risk for sarcopenia to take actions that will promote early detection and treatment. We also encourage more research in the field of sarcopenia in order to prevent or delay adverse health outcomes that incur a heavy burden for patients and healthcare systems.

6,250 citations

Journal Article
TL;DR: In this article, the optimal characteristics of strength-specific programs include the use of concentric (CON), eccentric (ECC), and isometric muscle actions and the performance of bilateral and unilateral single and multiple-joint exercises.
Abstract: In order to stimulate further adaptation toward specific training goals, progressive resistance training (RT) protocols are necessary The optimal characteristics of strength-specific programs include the use of concentric (CON), eccentric (ECC), and isometric muscle actions and the performance of bilateral and unilateral single- and multiple-joint exercises In addition, it is recommended that strength programs sequence exercises to optimize the preservation of exercise intensity (large before small muscle group exercises, multiple-joint exercises before single-joint exercises, and higher-intensity before lower-intensity exercises) For novice (untrained individuals with no RT experience or who have not trained for several years) training, it is recommended that loads correspond to a repetition range of an 8-12 repetition maximum (RM) For intermediate (individuals with approximately 6 months of consistent RT experience) to advanced (individuals with years of RT experience) training, it is recommended that individuals use a wider loading range from 1 to 12 RM in a periodized fashion with eventual emphasis on heavy loading (1-6 RM) using 3- to 5-min rest periods between sets performed at a moderate contraction velocity (1-2 s CON; 1-2 s ECC) When training at a specific RM load, it is recommended that 2-10% increase in load be applied when the individual can perform the current workload for one to two repetitions over the desired number The recommendation for training frequency is 2-3 d·wk -1 for novice training, 3-4 d·wk -1 for intermediate training, and 4-5 d·wk -1 for advanced training Similar program designs are recommended for hypertrophy training with respect to exercise selection and frequency For loading, it is recommended that loads corresponding to 1-12 RM be used in periodized fashion with emphasis on the 6-12 RM zone using 1- to 2-min rest periods between sets at a moderate velocity Higher volume, multiple-set programs are recommended for maximizing hypertrophy Progression in power training entails two general loading strategies: 1) strength training and 2) use of light loads (0-60% of 1 RM for lower body exercises; 30-60% of 1 RM for upper body exercises) performed at a fast contraction velocity with 3-5 min of rest between sets for multiple sets per exercise (three to five sets) It is also recommended that emphasis be placed on multiple-joint exercises especially those involving the total body For local muscular endurance training, it is recommended that light to moderate loads (40-60% of 1 RM) be performed for high repetitions (>15) using short rest periods (<90 s) In the interpretation of this position stand as with prior ones, recommendations should be applied in context and should be contingent upon an individual's target goals, physical capacity, and training status

3,421 citations

Journal ArticleDOI
TL;DR: It is concluded that multilevel interventions based on ecological models and targeting individuals, social environments, physical environments, and policies must be implemented to achieve population change in physical activity.
Abstract: ▪ Abstract The thesis of this article is that multilevel interventions based on ecological models and targeting individuals, social environments, physical environments, and policies must be implemented to achieve population change in physical activity. A model is proposed that identifies potential environmental and policy influences on four domains of active living: recreation, transport, occupation, and household. Multilevel research and interventions require multiple disciplines to combine concepts and methods to create new transdisciplinary approaches. The contributions being made by a broad range of disciplines are summarized. Research to date supports a conclusion that there are multiple levels of influence on physical activity, and the active living domains are associated with different environmental variables. Continued research is needed to provide detailed findings that can inform improved designs of communities, transportation systems, and recreation facilities. Collaborations with policy resear...

2,696 citations

Journal Article
TL;DR: Definition: To what extent does the study allow us to draw conclusions about a causal effect between two or more constructs?
Abstract: Definition: To what extent does the study allow us to draw conclusions about a causal effect between two or more constructs? Issues: Selection, maturation, history, mortality, testing, regression towrd the mean, selection by maturation, treatment by mortality, treatment by testing, measured treatment variables Increase: Eliminate the threats, above all do experimental manipulations, random assignment, and counterbalancing.

2,006 citations

Journal ArticleDOI
TL;DR: Neighborhood disparities in access to food are of great concern because of their potential to influence dietary intake and obesity and additional research is needed to address various limitations of current studies, identify effective policy actions, and evaluate intervention strategies designed to promote more equitable access to healthy foods.

1,874 citations