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BODY COMPOSITION STATUS OF A PHYSICALLY INDEPENDENT 86-YEAR-OLD MAN: A CASE REPORT

A physically active lifestyle is known to be beneficial for optimal aging. However, as people get older, sedentary lifestyles become more prominent, especially in populations over the age of 80. The increase in sedentary behaviors can make the studying of geriatric populations challenging and limiting. Thereof, this descriptive study presents the case report of an 86-year-old man who has been physically active for over a decade. This study highlights the utilization of a dual-energy X-ray absorptiometry scan to assess the body composition of the participant, along with a qualitative interview to examine the lifestyle of the participant. Overall, the participant presented an optimal amount of body fat percentage and bone mineral density. In addition, the participant reported having a satisfactory quality of life, which are benefits linked to the participant remaining physically active after major surgical procedures. Altogether, this study denotes the importance of physical activity for healthy aging. Contribution/Originality: This case study highlights the body composition of an 86-year-old man that is part of an understudied age group. Importantly, this case study denotes how a physically active lifestyle has been critical for maintaining a good quality of life and sustaining healthy aging.


DISCUSSION
Aging is associated with a decline in cognitive function, muscle strength, flexibility, agility, endurance, and increased fat mass (McPhee et al., 2016;Milanović et al., 2013). In this context, evidence suggests that frequent engagement in physical activity and exercise is an effective approach to reducing the aging-associated functional decline (McPhee et al., 2016). Though, this evidence is not new and has been well concluded that the risks of falls, disease progression, and metabolic disturbances can be reduced with an active lifestyle. However, this case report highlights a rather unique event for two reasons: First, the participant of this case report is an 86-year-old man, which categorizes him as part of a population (> 85 years) that warrants further studying. For example, a recent systematic review included 116 randomized controlled trials as part of an update to disseminate the effectiveness of the World Health Organization guidelines on physical activity in preventing falls for people over the age of 65 (Sherrington et al., 2020). In this systematic review, out of the 116 included studies, only 30 of them have participants with a mean age of 80 years or higher, while only 3 studies included participants over the age of 85.
Secondly, the participant illustrated in this case report had body composition measured via dual-energy X-ray absorptiometry, which provides a good estimate of muscle and fat mass and compares bone mineral density in relation to other studies. The purpose of this case report was to illustrate how being physically active and engaging in frequent exercise has helped the participant to remain functionally independent and maintain an optimal body composition following major surgical procedures.
Based on BMI, the participant is classified as slightly overweight. However, accounting for body fat percentage, contrasted to a study that also used dual-energy X-ray absorptiometry with physically inactive (3hrs < of exercise/week) and overweight older male and female adults (age: 50 ± 23 years) (Tomlinson, Erskine, Morse, & Onambélé, 2019), their participants had a body fat percentage of 36.2% compared to our participant who had a body fat percentage of 26.7%. Although caution of interpretation must be given because they combined males and females, the mean body weight and fat mass were 77.1 ± 9.1 kg and 26.9 ± 4.1kg, respectively, while our participant weighed 80.9 kg and had a total fat mass of 21.6 kg, indicating that our participant not only is heavier but has a lower fat mass. Furthermore, compared to another study where individuals with an average age of 70 years lost a significant amount of fat mass after 8 weeks of frequent aerobic or resistance exercise compared to the control group who was sedentary and gained fat mass (Irving et al., 2015); such study provides results in alignment to our participant who is older and is also benefiting from being active throughout the whole week by having a noticeably lower body fat percentage than adult males over the age of 60 years (Silveira, Barbosa, Noll, Pinheiro, & de Oliveira, 2021 arguably one of the most effective non-pharmacological approaches to improved sleep for older adults (Brewster, Riegel, & Gehrman, 2018). In connotation with this, it is suggestive that the active lifestyle of the participant in this case study not only helps him to have a good body composition but also a restful sleep pattern. In hindsight, although research is lacking in older adults, young individuals with poor sleep have shown to have increased visceral fat deposition that predisposes them to a higher inflammatory state and cardiovascular risk (Gaines et al., 2016). The participant of this case study had a visceral fat area of 127 cm 2 , a waist-to-hip ratio of 0.87, and android with a higher predisposition of visceral fat storage than in other body compartments (Hunter, Gower, & Kane, 2010), and an expected visceral fat area value for the average male of 60-69 years would be around 162 cm 2 .
Although there is limited evidence to infer this from, it is likely that visceral fat content would continue to rise and be higher in someone that is 86 years old (Hunter et al., 2010), yet that is not the case for the participant of this case report.
In addition, it must be acknowledged that to date, there is no preset diet that works for everyone, and rather, there are suggestions that help some people more than others. Within this context, the participant in this case report primarily follows a Mediterranean type of diet. To adhere to this diet style, he reported that every meal is freshly home cooked, allowing him to minimize the consumption of processed foods. This by itself is likely a critical favoring factor towards the good body composition of the participant (Panagiotakos, Polystipioti, & Papairakleous, 2007;Roman, Carta, Martínez-González, & Serra-Majem, 2008). In addition, combined with their active lifestyle, this has allowed them to remain energized, healthy, and eat normal meals as they reported no decrements in appetite. This last point is important because frailty in older adults (Capurso, Bellanti, Lo Buglio, & Vendemiale, 2019) is in part linked to weight loss due to a reduced appetite and therefore reduced energy intake.
An additional aspect to highlight is the high bone mineral density and T-score of the participant in this case report. In males and females over the age of 78, evidence purported that low-intensity exercise provided sufficient stimuli to promote an increased bone mineral density alike a vigorous resistance training program (Villareal et al., 2004). Such statement might be true for the participant of this case study, as they do not engage in vigorous exercise, and rather engage in frequent and daily physical activity that they described as essential to maintain an independent and good quality of life. Despite having major surgical procedures, the participant acknowledged that being physically active has been critical for his recovery and well-being as well. Altogether, this case report highlights the benefits of an active lifestyle in a geriatric participant of an age group that warrants further research.
Because there are ample complications when it comes to studying geriatric populations, this case report should be interpreted with caution and only serves as a summary of findings of a research participant that cannot be generalized or expected in someone of the same age. However, in the context of this participant, it has been evident that an active lifestyle and frequent exercise have been vital for his quality of life.

CONCLUSION
Interpretation of the findings in this case report cannot be generalized to all individuals. However, the participant in this case report, who has been physically active and engaged in frequent exercise, has enabled to maintain a healthy body composition regardless of his age. This has bolstered him to remain physically independent and achieve a good quality of life.
Funding: This study received no specific financial support.