Chronic stress level and functional health in older adults: the impact and role of fear of falling [FEARFALL]

• Applicants: Dr. Sabine Britting; Professor Nicolas Rohleder, Ph.D.
• Subject Area: Biological Psychology and Cognitive Neuroscience
• Term: since 2021
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 465677295

Maintenance of physical function, mobility and ability to live independently are important goals for older persons. However, this is counteracted by age-related loss of muscle mass, strength and function. Furthermore, this degenerating process can be reinforced if the older person avoids physical activity and exercise due to fear of falling. We established that fall-related psychological concerns (FrPC) are not only leading to decreased physical activity, but are also associated with elevated levels of inflammation. Consistent with that, long-term exposure to adverse psychological conditions, including chronic stress and anxiety, have been linked to the upregulation of inflammatory activity. This chronic low-grade activation of the immune system was shown to intensify the decay of skeletal muscle. Therefore, a vicious, feed-forward cycle of fear of falling, inflammation, loss of muscle mass and decreasing physical function is created that ultimately results in negative health outcomes, i.e. falls, dependence and death. Exercise training alone is not likely to interrupt this cycle, because a person with elevated FrPC would experience high stress and thus more inflammatory cytokines, blunting the anabolic effects of the intervention. Therefore, the planned study will utilize a multi-component intervention with exercise training and cognitive-behavioral components to address FrPCs and oppose muscular decay. For this aim, the expertise of a psychological and a geriatric institute is necessary. The randomized controlled trial will be conducted using established effective training programs for reduction of FrPC. The intervention group will conduct at least one 60 min exercise session per week and an additional home program, while a sham control group will receive a multicomponent intervention including sham activity, cognitive training and educational health lecture at the same frequency. For the operationalization of specific FrPCs the Falls Efficacy Scale - International (FES-I) will be used. Stress and related psychological symptoms will be monitored by established self-reports and by measuring salivary cortisol. Concentrations of C-reactive protein, interleukin 6, interleukin 10 and tumor-necrosis-factor-alpha, as well as gene expression of select inflammatory transcripts, will be used as surrogate parameters of the inflammatory status at baseline and at several time-points during the intervention and follow-up. This will allow us to test whether the reduction of specific FrPCs or general psychological symptoms will reverse alterations in stress systems, and / or slow down low-grade inflammation. We will measure changes in activity, as well as psychological and biological pathways leading from FrPCs to muscle loss, to disentangle the individual contribution to sarcopenia, and to provide an additional pathway to break or slow-down the vicious cycle of FrPCs and sarcopenia.

• DFG Programme: Research Grants
• Co-Investigators: Privatdozentin Dr. Ellen Freiberger; Professor Dr. Cornel Sieber