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Background and purpose: Decreased balance in standing and walking is a common problem of hemiparesis following stroke. The purpose of this study was to quantify and compare the balance control between right and left hemispheric stroke patients and to determine the effect of balance, functional and strengthening exercises on both groups of patients.
Methods and Materials: This clinical trial was performed in Kahrizak Çharity Foundation in 1382. Thirty four hemiparetic patients secondary to stroke aged 52.41 ± 6.19 years and 37 ± 26.37 months since stroke participated in the study through simple non-probability sampling. Ônly those patients were enrolled into the study that the time since the onset of stroke was at least 12 months. Patients were assigned randomly to two groups. The balance was measured with BBS (Berg Balance Scale) and FMÂ (Fugl-Meyer Âssessment) before and after 12 sessions of intervention. Ône group received only functional and balance exercises. The other group received strengthening exercises in addition to functional and balance exercises. Ïndependent t, Mann-Whitney and Çhi-square tests were used for comparison between the two groups and to investigate the relationship, respectively.
Findings: There was no significant difference in balance function measures (ordinal scale) between left and right hemiparesis with mean of 50.33±9.13 and 51.69±7.67, respectively (P=0.658). Regardless of the type of exercises, no difference was seen between left (mean difference, 10.86) and right (mean difference, 10.77) hemiparesis after intervention (P= 0.909). Significant difference was not seen between left (mean difference, 18.33) and right (mean difference, 15.88) hemiparesis after intervention in strengthening exercise group (P = 0.448).
Çonclusion: Ôur results suggest that there are no difference in balance function between left and right hemiparesis and recovery of balance in these patients following strengthening exercises and it was not dependent on the involved side.

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Background and purpose: Low back pain (LBP) is one of the most common and costly musculoskeletal disorders. Dysfunction of spinal stability seems to be one of the causes of LBP. Â large number of muscles have a role in spinal stability including pelvic floor muscle. The purpose of this study was to compare the pelvic floor muscle endurance and strength between women with LBP and healthy subjects.
Materials and methods: Â Çase-Çontrol study was carried out on 20 women with chronic LBP and 20 healthy women aged between 20 to 50 years. Participants were randomly selected and allocated into a patient and a healthy control group. Pelvic floor muscle endurance and strength were measured in both groups using perineometer instrument. Pain intensity and functional disability in patients group were also measured using visual analogue scale and Ôswestry disability questionnaire, respectively.
Results: Results demonstrated that there was statistically significant differences regarding pelvic floor muscle endurance and strength between the patients and the healthy groups (P<0.05 in both instances). Pearson correlation coefficient revealed that there was no statistically significant correlation between age and muscles endurance and strength in both groups (P>0.05 in all instances). Â significant correlation was found between pain and functional disability with endurance and strength in patients group. The correlation of body mass index and parity was only significant with muscle endurance and only in the patients group (P<0.05 in both instances).
Çonclusion: Results of the present study indicated that pelvic floor muscle strength and endurance in patients group were significantly lower than healthy subjects. However, further studies with larger sample size are recommended to support the findings of the present study and to prevent such a health problem in women.

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Background and purpose: Human muscle strength is affected by life style, physical activities and recreation. Lower limbs antigravity muscles weakness has significant role in falling. Because of great effects of balance and muscle strength in health of the elder population, the purpose of the present study was to evaluate the effects of aging on muscle strength and to determine the age range of muscle strength reduction in women aged 21 to 80 years old.
Materials and methods: This cross-sectional study was performed on 101 healthy subjects. The subjects were divided into six age groups with 15 to 20 women in each group. Maximum isometric strength of four muscle groups was measured using a hand-held dynamometer, bilaterally.
Results: The results indicated that the muscle strength was significantly decreased with aging (P<0.0001). The force changes in hip extensor and ankle dorsiflexor muscles were not significant between age 21 to 40 years, but after that it was significantly reduced (P<0.0001). The changes of knee extensor and hip abductor muscles force were not significant up to 50 years old, but after that a significant decrease was found.
Çonclusion: Âccording to the results, it can be predicted that the aging and associated loss of muscle strength leads to a significant decrease in standing balance and stability. Therefore, planning sufficient physical activities among the all age groups at risk of falling is necessary. With appropriate exercise therapy program, balance disorders and falling among the elder population can be prevented.

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Background and purpose: Ultrasonography is a reliable and valid method to assess the strength of neck extensors and measuring the neck muscles dimensions. Cervical muscles strength and dimensions may change in different positions. The aim of this study was to compare the strength of cervical extensor muscles and dimensions of semi-spinalis capitis muscle (SECM) in three different neck positions in healthy female individuals. Materials and methods: The research population included 30 female students, 18-24 years of age. Right SECM at the level of third cervical vertebrae was measured by ultrasonography in order to assess the isometric strength of neck extensor muscles in neutral, flexion and extension positions. The size of muscle was calculated by multiplying the anterior-posterior and lateral dimension of the muscle. Afterwards, the muscle strength was measured by a measuring device. One way-ANOVA was used to analyze the data. Results: The SECM size was significantly bigger in extension than that of the neutral and flexion positions (P<0.001). The strength of extensor muscles in neutral position was more than that of the flexion and extension positions. However, there was not a significant correlation between size and strength of the muscle in all three positions. Conclusion: The result of this study indicated that the size of SECM increased in extension position while the strength of neck extensor muscles decreased. The maximum performance of cervical extensor muscles appeared in neutral position of cervical spine, when the muscles were not maximally lengthened or shortened.

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Background and purpose: The Calcitonin Gene-Related Peptide (CGRP) is a potent dilator of cerebral vessels and that now thought to play a central role in the underlying pathophysiology of migraine. The purpose of present study, therefore, was to investigate effects of endurance, resistance, and strength training on CGRP content in Wistar rat’ trigeminal nerve. Materials and methods: A number of 21 rats randomly assigned into four groups including Control, Endurance, Resistance, and Strength training. Treadmill running endurance protocol including 5 days a week, 60 min/day, 30 m/min speed, animals of the resistance training group were housed in metal cage with a wire-mesh tower the strength training protocol consisted of climbing a 1-meter–long ladder. Forty-eight hours after last session of protocol, animals were anaesthetized and trigeminal nerve ganglion was exited after head separating and skull excision. Then, tissues were quickly frizzed in liquid nitrogen. For data analyses, one way ANOVA was used. Results: Data analysis showed that there was a significant different between control and strength training groups in trigeminal nerve ganglion CGRP (P= 0.03). But, the content of CGRP in trigeminal nerve ganglion was not significantly different in endurance and resistance groups compared with control group (respectively, P= 0.35 and P= 0.57). Conclusion: It is considered that intensity of training plays a key role in CGRP increase. It is suggested that moderate to low intensity of physical activity probably lead to less CGRP release in brain vessels and trigeminal nerves.

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Background and purpose: Internal assessment is an introduction for improving the quality and the first step of accreditation. Identifying the competencies and the weaknesses enables the organizations to choose the strategies to face environmental forces. This study aimed to identify the strengths and the weaknesses of hospitals in Gorgan and the Gonbad-e Qabus cities, Iran. Materials and methods: This cross-sectional study was performed in Azar the 5th, Deziani, and Taleghani hospitals in the city of Gorgan and Shahid Motahari and Shohola hospitals in the city of Gonbad-e Qabus. Statistical Society was included 322 clinical and non-clinical staff of the hospitals. Data collection instrument was a questionnaire. The data were analyzed using ANOVA, t, and Pearson correlation tests. Results: 83.5% of respondents considered desirable internal hospital environment and 16.5% of them considered undesirable. The weakest area was rewards and the strongest area was target. There were significant relationships between internal environment of hospitals and years of services (P = 0.030), ward (P = 0.008), and hospital (P = 0.021) but there were not significant relationships between internal environment of hospitals and age (P = 0.371), sex (P = 0.559), employment status (P = 0.527), and level of education (P = 0.110). Conclusion: Internal environment status was good from employee's viewpoint but rewards need to improve. It is necessary for managers to give rewards to personnel practice-basely and individually.

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Background and purpose: Nitrate is probably the most widespread groundwater contaminant in the world, due to its high water solubility. It imposes a serious threat to human health and contributes to eutrophication. The objectives of this study were set to explore how the factors of ultraviolet light and ionic strength could influence the nano zero valent iron (NZVI) system for nitrate removal. Material and methods: In this study, response surface methodology was employed for the design and analysis of experiments .Experiments were carried out as per Box–Behnken) BBD) surface statistical design with four input parameters namely NZVI dose (0.5–2g/L), initial concentration (50–150mg/L), contact time (15–60min), and ionic strength (1000-5000μmho/cm). All experiments were performed in the presence and absence of UV irradiation. Results: The Maximum reduction efficiency for experiments in the presence and absence of UV irradiation was 85.3% and 91.6% in nano zero valent iron dose 2g/L, initial concentration 100mg/L, Contact time 60, and ionic strength 3000μmho/cm. The proposed model was essentially in accordance with the experimental case with correlation coefficient R2 = 0.9992, 0.9946 and Adj-R2 = 0.9982, 0.9884, respectively. Conclusion: Removal efficiency of nitrate increased with increase in time and NZVI dosage. In contrast, it decreased when ionic strength and initial concentration increased. Also, UV irradiation accelerated the removal of nitrate.

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Background and purpose: From many years ago denture adhesives have been used to improve denture’s performance. During the time, many new formulations have been prepared and evaluated to improve the properties of this product. In this study, the powder form of this product was prepared then in vitro and in vivo evaluations were performed. Material and Methods: To design the denture adhesive powder, sodium alginate, plantagopsyllium mucilage and sodium carboxy methyl cellulose were used as the main binding agents. Different formulations with different ratio of these three agents were prepared, then, their binding strength and duration of efficacy were evaluated in the lab. Finally, the best formulation was chosen for in vivo evaluation. Results: The study showed that prepared formulations containing sodium alginate and NaCMC with ratio of 95:5 had higher binding strength ability and duration of efficacy than artificial saliva. This formulation also had positive effect on the performance of denture during eating and speaking and also prolonged the adhesion period of denture. No significant differences were seen between this formulation and protefix in performance properties but in other properties like odor and flavor the prepared product were found better than protefix. Conclusion: This experimental study showed that the mixture of sodium alginate and NaCMC with more ratio of alginate 95:5 is a proper product to be used as a denture adhesive.

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Background and purpose: Functional disabilities due to stroke produce a wide range of problems in daily activities. Rehabilitation approaches focus on preventing and reducing contractures and deformities. But constraint-induced therapy focuses on improving the performance of hemiplegic patients. The purpose of this study was to investigate the effects of constraint-induced therapy on strength and dexterity in adults with hemiplegia. Materials and methods: The study population included 17 adult hemiplegics patients aged 50-70 years. The mean age of the patients was 64.23 with RT side dominancy and the time passed from stroke was 6 months (mean time= 23.70 months). Informed consent was obtained from the patients. Abductor and extensor muscles isometric strengths were measured using MMT. Also, pinch and grip strength was measured by Pinch Gauge and Jamar dynamometer, respectively. In addition, dexterity was evaluated by Minnesota manual dexterity test. Results: Constraint-induced therapy showed significant improvement in the performance of pinch and grip strengths, abductor and extensor muscles isometric strengths and dexterity (P=0.000). Conclusion: Constraining the normal limb improves the performance of other affected limbs. This study suggests that constraint-induced movement therapy is of great benefit in increasing the isometric strength of shoulder extensor and abductor muscles, pinch and grip strength and dexterity. These improvements could consequently affect hand function in hemiplegic patients.

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Background and purpose: The aim of this study was to compare the effect of routine and fun physical activities on degree of mobility and muscle strength in elderly residents in nursing homes in Mashhad.

Materials and methods: A randomized clinical trial was conducted (in 2013-2014) in which two groups of elderly living in nursing homes in Mashhad were recruited. Data was collected using Elderly Mobility Scale and Dynamometer (T.K.K.5401). The intervention group participated in fun physical activities while the control group had routine physical activity. Both types of exercises were conducted 20 minutes every other day for 8 weeks.

Results: Significant differences were seen between the two groups in mean score of mobility and muscle strength after the intervention.

Conclusion: Motivating elderly to begin fun exercise could increase their level of activity, thereby preventing movement disorders among this population.

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Background and purpose: Repetitive strain injury (RSI) is accompanied by an increase in extracellular matrix (ECM), atrophy, and reduces the muscle power. Resistance training (RT) have potential positive effects on muscle function and morphology in elderly. This research examined the effects of eight week therapeutic resistance training on recovery of pathological changes after 6weeks chronic eccentric contraction.

Materials and methods: Eighteen elderly male Wistar rats were divided into three groups (control, RSI-rest, RSI-RT). Two experimental groups underwent 6weeks (5 days/week) of fast velocity submaximal eccentric contractions while the control group was inactive. After two weeks rest, RSI-RT group performed 8 weeks resistance training and RSI-rest group was detrained for 8 weeks. Gastrocnemius muscle response was assessed by isometric force and muscle wet mass. Quantitative histopathological analysis was also done in all groups.

Results: Gastrocnemius tissue of injured limbs showed increase in ECM and decrease in myofiber area and isometric force after 6 weeks RSI model in RSI-rest group, but muscle wet mass did not change. RT significantly improved isometric force, myofiber area percent but decreased non-contractile area percentage. However, pathological changes after RSI were not fully recovered by RT.

Conclusion: Therapeutic Resistance training with an emphasis on concentric phase, low velocity and adequate rest can attenuate functional and histopathological changes in muscle after chronic strain injury in elderly rats.

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Background and purpose: In recent years, consumption of commercial protein supplements and hormones that improve body appearance endangers the health of athletes especially in bodybuilding sport. Recently, use of plant extracts to reduce the side effects of drugs and improving physical activity has gained a lot of attention. The aim of this study was to investigate the effect of a supplement (mixture powder of Fenugreek seeds, rhizomes of Ginger and Alhaji manna) on increasing muscle strength and body composition in athletes in Mashhad, Iran, 2015.

Materials and Methods: A quasi-experimental study with pretest and posttest design was carried out in which 40 male athletes were selected using stratified random sampling. The participants had at least one year activity in fitness clubs. They were divided into control and experimental groups
(n = 20 per group). The experimental group performed specific exercises for six weeks and had a daily intake of 5 grams of the supplement (in non-training days and one hr before the exercises). Data analysis was done in SPSS V.20 applying Mann Whitney and Wilcoxon tests.

Results: The Wilcoxon test showed that taking the supplement in six weeks of bodybuilding exercises increased the factors influencing body composition and muscle strength in the experimental group (p≤0.05).

Conclusion: According to this study, a mixture powder of Fenugreek seeds, rhizomes of Ginger and Alhaji manna is helpful in improving muscle strength and body composition in athletes.

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Background and purpose: Previous research has shown that improving lower extremity muscle strength plays an important role in prevention of falls in older people. The aim of this study was to investigate the relationship between the changes of lower extremity muscle strength and postural control ability in elderly after a hydrotherapy program.
Materials and methods: In a clinical trial, 30 elderly male were randomly selected and classified into intervention (mean age 65.4 years, mean height 169.3 cm, and mean weight 70.8 kg) and control groups (mean age 63.6 years, mean height 1688 cm, and mean weight 70.9 kg). The intervention group participated in an aquatic exercise program for 8 weeks while the control group had no intervention. Postural sway parameters and muscle strength were evaluated before and after the program using the Biodex balance system and hand held dynamometer (HHD) respectively. Pearson correlation test was used for data analysis (P≤0.05).
Results: The results showed a significant relationship between the changes of plantar flexors muscle strength and postural control ability after the intervention (P<0.05), but this relationship was not significant in the case of other muscles (P>0.05).
Conclusion: Compared with other lower extremity muscles, increase in plantar flexors muscle strength seems to have a major role in improving the postural control ability in elderly people. So, posterior muscles of the leg should be considered in planning exercises that aim at improving balance in older people.
 
(Clinical Trials Registry Number: IRCT2016031227022N1)
 

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Background and purpose: Leveling of health services and resources is implemented in Iran to promote the health situation and preventing unnecessary visits and waste of human and financial resources. The relationship between these levels is built through referral system. The aim of this study was to analyze the patient referral system at all levels of the health system using Strengths, Weaknesses, Opportunities and Threats (SWOT) approach.
Materials and methods: This qualitative study was done by semi-structured and in-depth interviews in 2016. The sample size consisted of 20 people including administrative officers, family physicians, executive managers, and individuals working in insurance sector and 10 people receiving insurance services who were selected purposefully. Data was analyzed using content and structural analysis.
Results: The strengths included: reducing the costs, providing equitable access to health services, promoting the health level, and providing services in an evolutionary level. The weaknesses included not informing the people, physician issues, poor monitoring and evaluation, management issues, payment mechanisms, electronic health records, insurance organizations, and inadequate facilities and equipment of health centers. Opportunities included: the importance of health and health care for the leadership and the parliament, job creation, active participation of the private sector, the high level of literacy of the target group (people), and the cooperation of insurance organizations. The threats included lack of coordination and alignment between policy makers and planners, the therapeutic focus of health system, lack of attention of people to health care, and the influences of private sector.
Conclusion: The appropriate implementation of referral system promotes the health of society and increases the healthcare burden. But today, it does not follow its own rules which is caused by different factors. Therefore, health authorities should address these by appropriate planning and timely actions.
 

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Background and purpose: Osteoarthritis of the hand is one of the most prevalent joint diseases in older adults. Hand has a key role in daily activities, therefore, its impairment causes disability and reduces independency. This study aimed to compare the effectiveness of Kinesio taping and hand exercise on pain, range of motion, and grip strength in patients with hand osteoarthritis.
Materials and methods: In this experimental study, 20 patients with hand osteoarthritis were randomly assigned to either Kinesio taping group or exercise group. Visual analogue scale, goniometer and dynamometer measurements were used to assess the severity of pain, range of motion, and grip strength, respectively, at baseline and two months after the intervention. In Kinesio taping method the tape was applied only on wrist extensor muscles and thumb. In other group, conventional rehabilitation interventions were used. 
Results: In this study, grip strength and range of motion improved after intervention in both groups, but pain intensity was significantly less in the group applying Kinesio taping (P= 0.001). More improvements were seen in grip strength in exercise group. There were significant differences between the two groups in pain and grip strength (P= 0.043, P= 0.028, respectively).
Conclusion: In current research, Kinesio taping and hand exercise showed positive effects on pain, range of motion, and grip strength in patients with hand osteoarthritis.

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  Background and purpose: The bonding process is highly important in orthodontic treatment for its fast speed. The purpose of this study was to compare the shear bond strength of ceramic and metallic brackets between three stage (transbond^TM XT) and two stage (GC ortho connect^TM) light cure composites.
Materials and methods: In this experimental study, 80 maxillary and mandibular first and second premolar teeth, extracted for the purpose of orthodontic treatment, were randomly divided into four groups (n=20 per group). All teeth were etched using 35% phosphoric acid. They were then bonded with metallic brackets with GC ortho connect^TM composite (group I), and Transbond^TM XT composite (group II), and ceramic brackets with GC ortho connect^TM composite (group III) and Transbond^TM XT composite (group IV). The shear bond strength of the brackets was measured by universal testing machine 24 hours after thermocycling and mounting procedures. The amount of resin remained on the tooth surface was determined by stereomicroscope. Data were analyzed by SPSS V22 applying Kruskal–Wallis one-way analysis of variance.
Results: The average shear bond strength in groups I, II, III, and IV were 18.71±1.99, 19.82±8.75, 18.4±5.78, and 18.5±52.42 MPa, indicating no significant differences between the groups studied (P> 0.05). Also, we found no significant differences in adhesive remnant index (ARI) between all groups (P=0.641).
Conclusion: The shear bond strength of GC ortho connect^TM composite was similar to that of the Transbond^TM XT composite in both metallic and ceramic brackets. Therefore, GC ortho connect^TM can serve as a substitute for Transbond^TM XT.
  

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Background and purpose: Almost half of non-specific knee pain can be attributed to patellofemoral pain syndrome (PFPS). There is paucity of information about the effects of different types of combination therapies including exercise and taping and optimizing training variables. The aim of this study was to evaluate the effectiveness of combination of taping and quadriceps strengthening and hamstring stretching exercises on PFPS.
Materials and methods: In a randomized clinical trial, 60 male patients (20-50 years old) with PFPS were randomly divided into four groups: 1) Quadriceps strengthening exercise and taping, 2) Hamstring stretching exercise and taping, 3) Quadriceps strengthening and hamstring stretching exercise, and 4) Quadriceps strengthening, hamstring stretching exercise, and taping. Pain and functional outcomes were assessed before and immediately after treatment using VAS scale, KOOS scale, and 6 MWT test. Data were analyzed in SPSS V20.
Results: Compared to beginning of the study, significant decrease in mean VAS scores (P<0.001) and significant increase in mean KOOS scores and 6 MWT test were found in all groups after treatment (P<0.001). However, the increase in 6MWT test score was not significant in group 4.
Conclusion: Combination of quadriceps strength training and hamstring stretching improved PFPS in all four groups. Lack of significant differences between the groups studied suggests that combination of two treatments has a similar effect to the combination of three treatments.
 
(Clinical Trials Registry Number: IRCT20140708018409N2)

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Background and purpose: Bracket debonding is a major problem during orthodontic treatment. This research aimed at studying shear bond strength (SBS) and adhesive remnant index (ARI) in two bonding systems (Assure Plus (adhesion booster) and control).
Materials and methods: In this vitro trial, premolars (n=90) were divided into two groups. The brackets were bonded either with Transbond XT or Assure Plus. After aging and thermocycling, SBS was measured by universal testing machine. ARI scores were recorded using stereomicroscope. Data were analyzed in SPSS V20 applying One-way and two-way analysis of variance, Tukey test, and Kruskal-Wallis test. Spearman correlation coefficient was calculated to determine any correlation between bond strength and ARI scores.
Results: Aging had no significant effect on SBS in Assure Plus samples (P=0.252) but in Transbond XT, samples with 6 months of aging had significantly lower bond strength compared to 24 hours (P=0.001) and 3 months (P=0.000) of aging. There were no significant differences between Transbond XT and Assure Plus when aged for 24 hours (P=0.280) or 3 months (P=0.114) but when aged for 6 months, Assur Plus had significantly higher bond strength (P=0.000). Spearman correlation test showed significant and direct relation between ARI score and SBS (r=0.834, P<0.001).
Conclusion: Shear bond strength of Assure Plus was not affected by aging, so it could be useful when higher bond strength is needed for longer period of time.

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Background and purpose: In orthodontic brackets, unlike restorative materials or porcelain, the shear bond strength of the adhesives used is important because the oblique forces from food or objects or the tension of the adhesive food affect the brackets. This study aimed at measuring and comparing shear bond strength and adhesive remnant index of light cure composite, no mix (self-cure) composite, and no bond composite (GC Orthoconnect).
Materials and methods: A total of 27 non-carious and sound human premolar teeth were used. The samples were divided into three groups, including light cure composite, self-cure composite, and no bond composite (GC Orthoconnect). After bonding and thermocycling process, the metal brackets (American Orthodontics) were then debonded using universal testing machine. Adhesive remnant index (ARI) score was assessed.
Results: The highest and lowest SBS mean values were seen in self-cure group (18.0402±5.71665) and light cure group (7.7890±3.98995), respectively. There were significant differences in SBS values between all groups except between the no bond group and the self-cure group (P= 0.18, P>0.05). The highest ARI scores were 0 in the self-cure group and 3 in the no bond group and the light cure group.
Conclusion: The no bond composite provided acceptable overall shear bond strength and compared to light cure composite showed higher shear bond strength and lower bond failure.
 

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 Background and purpose: Anthropometric measures are of great importance in evaluating older adult health. This study was carried out to examine five-year changes in anthropometric indices of older adults and its association with demographic characteristics, muscle strength, and comorbid disorders.
Materials and methods: This cohort study was conducted during 2011-2016 in people aged 60 years and over participating in the Amirkola Health and Ageing Project (AHAP). The elderly whose anthropometric characteristics were complete in the data bank of AHAP were included in the research by census. Demographic characteristics, comorbidities, and anthropometric measures, including height, weight, body mass index, neck, waist and hip circumferences, waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were assessed, and five-year changes were calculated.
Results: Among 897 people, significant reductions were seen in height, neck, waist, and hip circumferences, WHtR (P<0.001), and WHR (P=0.031). Change in weight loss was not statistically significant (P=0.152) and body mass index increased (P<0.001). Reductions in height, neck, waist and hip circumferences, and decrease in WHtR were found to be significantly different between women and men (P<0.001). There was a significant positive correlation between the number of comorbidities and five-year changes of height (r=0.104, P=0.002) and hip circumference (r=0.095, P=0.005), and a negative correlation between strength of the arm (r=-0.341, P<0.001) and quadriceps (r=-0.324, P<0.001) muscles and comorbidities.
Conclusion: This study represented a pattern of significant reduction in height, neck, waist, and hip circumference, waist-to-hip ratio and waist-to-height ratio, and increase in body mass index in older adults, over five years. Furthermore, significant correlations between comorbid disorders and changes in height and hip circumference, and muscle strength were shown.