Relationship between sarcopenia and physical activity in older people: a systematic review and meta-analysis

Sarcopenic Characteristics of Active Older Adults: a Cross-Sectional Exploration

BACKGROUND

Ageing is associated with a decline in skeletal muscle mass and function (strength and power), known as sarcopenia. Inadequate dietary protein and inactivity have been shown to accelerate sarcopenia outcomes, occurring at different rates in males and females. Regardless, active older adults who often exceed the exercise guidelines still show signs of sarcopenia. This study aimed to explore the link between age, physical activity, protein intake, and biological sex with skeletal muscle mass, strength, power, and physical capacity/performance in active older adults. Fifty-four active older adults were recruited from this trial and grouped according to age (middle aged: 50-59 years, and older age: ≥ 60 years), exercise volume (low: ≥ 90-149 min/week, moderate: ≥ 150-299 min/week, and high: ≥ 300 min/week), protein intake (low: < 0.8 g/kg body mass (BM), moderate: ≥ 0.8-1.19g /kg BM, and high: ≥ 1.2 g/kg BM), and biological sex (males and females). Skeletal muscle and fat mass (dual X-ray absorptiometry), strength (1-repetition maximum using leg press, chest press, lateral pull down, and hand grip), power (counter movement jump), and general fitness (cardiorespiratory capacity and gait speed) were assessed. Data were grouped based on variables, and a general linear model (ANCOVA) or an independent t test was used to determine between group differences.

RESULTS

Fifty three of the total participants' data were analysed. The middle-aged group had 18%, 11%, and 10% higher leg press, chest press, and lateral pull down, respectively, compared to the older-aged group (p < .05). There were no significant differences between different levels of training volume and any of the outcomes. Higher protein intakes were associated with significantly less body fat mass (p = .005) and a trend towards a higher leg press (p = .053) and higher relative power (W/kg) (p = .056) compared with the moderate and low protein intake groups. Significant differences based on biological sex were observed for all outcomes except for gait speed (p = .611) and cardiorespiratory fitness (p = .147).

CONCLUSIONS

Contributions of age, physical activity, daily protein intake, and biological sex can explain the individual variation in outcomes related to changes in body composition, strength, power, and/or cardiorespiratory fitness in a cohort of active older adults. The preprint version of this work is available on Research Square: https://www.researchsquare.com/article/rs-51873/v1 .

TRIAL REGISTRATION

This trial is registered in the ANZCTR.org.au, no. ACTRN12618001088235 ( https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375286 ).

The Association Between Sarcopenia and Postoperative Outcomes Among Older Adults With Hip Fracture: A Systematic Review

Hip fracture is a serious clinical event with high morbidity and mortality. Sarcopenia is characterized by age-related loss of muscle mass and function, leading to several adverse health outcomes. In this systematic review, no limitation criteria were used for study selection and 327 studies were identified in the initial search. Of these, 11 studies comprising a total of 2,314 patients were selected. The overall proportion of older adults with hip fracture having sarcopenia was 44%, with a disparity of approximately 10% between men and women. Most studies have indicated that older adults with sarcopenia had poorer postoperative functional recovery than those without sarcopenia; the association between sarcopenia and high postoperative mortality or long hospital stay was heterogeneous. Well-organized studies with longer follow-up periods are warranted.

The Comparisons of Physical Functional Performances between Older Adults with and without Regular Physical Activity in Two Different Living Settings

We compared the physical function performances of community-dwelling and day care center older adults with and without regular physical activity (PA). A total of 163 Taiwanese older adults living in rural communities participated. PA habits and physical functional performances were assessed. The participants were divided into community-dwelling (CD) and senior day care (DC) center groups that were further classified into regular physical activity (RPA) and non-physical activity (NPA) subgroups. Comparison took place between subgroups. In the CD group, only the grip strength, pinch strength, and box and blocks test scored significantly better for the participants with regular PA. Muscle strength, flexibility, and three items of functional ability of participants with regular PA were significantly better in the DC group. An active lifestyle contributes to a good old-age life. The effective amount of PA and the reduction of sedentary time should be advocated to prevent frailty and disability in older adults.

Sarcopenic obesity and function in women with subacute hip fracture: a short-term prospective study

BACKGROUND

The prognostic role exerted by the concurrent presence of sarcopenia and obesity after hip fracture has not been elucidated.

AIM

To assess the effect of sarcopenic obesity on ability to function in women with subacute hip fracture.

DESIGN

Short-term prospective study.

SETTING

Rehabilitation hospital.

POPULATION

Women with subacute hip fracture.

METHODS

At admission, grip strength, by a Jamar dynamometer, and body composition by dual-energy x-ray absorptiometry were assessed. Sarcopenia was defined according to the criteria released by the European Working Group for Sarcopenia in Older People in 2019, with both grip strength < 16kg and appendicular lean mass (aLM) < 15kg. Alternatively, aLM/(height)2 < 5.5kg/m2 was substituted for aLM < 15kg to confirm sarcopenia in the women with grip strength < 16kg. Obesity was diagnosed with fat mass exceeding 40% of total body mass. Function was assessed by the Barthel index.

RESULTS

We assessed 183 of 200 women. Sarcopenic women had lower Barthel index scores assessed at the end of subacute inpatient rehabilitation (U=300,0; z=-4.3; P<0.001) and lower Batrhel index effectiveness (U=310,0; z=-4.2; P<0.001) than non-sarcopenic women. Conversely, we found no significant differences in function between obese and non-obese women. The concurrent presence of sarcopenia and obesity did not worsen the functional prognosis versus the presence of isolated sarcopenia. After adjustment for Barthel index scores before rehabilitation, age, hip-fracture type and cognitive impairment, sarcopenia was significantly associated with Barthel index scores (P=0.001) and Barthel index effectiveness (P<0.001), whereas obesity was not. The results did not materially change when aLM/(height)2 < 5.5kg/m2 was substituted for aLM <15kg to confirm sarcopenia in the women whose handgrip strength was < 16kg.

CONCLUSIONS

The concurrent presence of obesity did not worsen the negative prognostic role of sarcopenia in the short-term recovery of ability to function after hip fracture in women.

CLINICAL REHABILITATION IMPACT

In women with subacute hip fracture, sarcopenia but not obesity should be assessed to contribute to the prediction of the short-term functional outcome.

Association between Levels of Physical Activity, Sarcopenia, Type 2 Diabetes and the Quality of Life of Elderly People in Community Dwellings in Lebanon

There is a lack of data from developing countries on the link between physical activity (PA) on health outcomes. This study examines the association between the level of PA and sarcopenia, cardiovascular risk factors (i.e., dyslipidemia, type 2 diabetes (T2D), and cardiovascular diseases), and the health-related quality of life (HRQoL) among elderly people, in community dwellings in Lebanon. In this cross-sectional, observational study, body composition, levels of PA, and the HRQoL of 243 elderly people living in community dwellings, are obtained. The participants are then categorized based on a PA cut-off point of 600 metabolic equivalent task minutes per week (MET-min/week). In our sample, the prevalence of physical inactivity, defined as performing less than 600 MET-min/week, is 51.44% (125/243 participants).They displayed a higher prevalence of sarcopenia (36.0% vs. 18.6%), T2D (39.6% vs. 21.1%), as well as a lower physical (65.67 ± 20.72 vs. 75.08 ± 17.29) and mental (67.58 ± 21.51 vs. 76.95 ± 17.16) HRQoL. On the other hand, regression analysis shows that an increased rate of PA to ≥600 MET-min/week is associated with a lower risk of T2D (OR = 0.43, 95% CI: 0.22–0.84, p = 0.013) and sarcopenia (OR= 0.40, 95% CI: 0.22–0.73, p = 0.003) by 60%, and higher scores of the physical (β = −7.65; −11.87, −3.43, p = 0.0004) and mental (β = −8.47; −13.08, −3.85, p = 0.0004) HRQoL by nearly eight points. Our results show a high prevalence of physical inactivity in Lebanese adults over the age of 60; however, an adequate level of PA among this population seemed to be associated with a lower risk of sarcopenia and T2D, as well as a better HRQoL. However, future longitudinal studies are still needed to clarify if intervention based on increasing levels of PA can determine improvement in these clinical outcomes. If this is shown to be the case, it emphasizes the importance of implementing strategies to increase physical activity within this population.

Morning fatigue and structured exercise interact to affect non-exercise physical activity of fit and healthy older adults

Background

Exercise training is crucial for maintaining physical and mental health in aging populations. However, as people participate in structured exercise training, they tend to behaviorally compensate by decreasing their non-exercise physical activity, thus potentially blunting the benefits of the training program. Furthermore, physical activity of older adults is substantially influenced by physical feelings such as fatigue. Nevertheless, how older people react to day-to-day fluctuations of fatigue and whether fatigue plays a role in non-exercise physical activity compensation is not known. Thus, the purpose of this study was twofold: (1) To explore whether the volume and intensity of habitual physical activity in older adults were affected by morning fatigue. (2) To investigate the effect of attending power and resistance exercise sessions on the levels of non-exercise physical activity later that day and the following day.

Methods

Twenty-eight older adults wore an accelerometer during a 4-week low-volume, low-intensity resistance and power training program with three exercise sessions per week and for 3 weeks preceding and 1 week following the program. During the same period, the participants were prompted every morning, using text messages, to rate their momentary fatigue on a scale from 0 to 10.

Results

Greater morning fatigue was associated with lower volume (p = 0.002) and intensity (p = 0.017) of daily physical activity. Specifically, one point greater on the fatigue scale was associated with 3.2 min (SE 1.0) less moderate-to-vigorous physical activity. Furthermore, attending an exercise session was associated with less moderate-to-vigorous physical activity later that day by 3.7 min (SE 1.9, p = 0.049) compared to days without an exercise session. During the next day, the volume of physical activity was greater, but only in participants with a body mass index up to 23 (p = 0.008).

Conclusions

Following low-volume exercise sessions, fit and healthy older adults decreased their non-exercise physical activity later that day, but this compensation did not carry over into the next day. As momentary morning fatigue negatively affects daily physical activity, we suggest that the state level of fatigue should be monitored during intensive exercise programs, especially in less fit older adults with increased fatigability.

Rehabilitative Good Practices in the Treatment of Sarcopenia: A Narrative Review

ABSTRACT

To date, rehabilitative good practices that analyze all aspects of the rehabilitation management of the patient with sarcopenia are absent in the literature. The purpose of this article is to carry out research and evaluation of the evidence, good practice, and recommendations in the literature relating to the rehabilitative treatment of disabilities associated with sarcopenia. Bibliographic research was conducted on Medline, PEDro, Cochrane Database, and Google Scholar. All articles published in the last 10 yrs were analyzed. The results of this research generated three guidelines, eight meta-analyses, five systematic reviews, a Cochrane review, 17 reviews, and seven consensus conferences. From the analysis of the literature, it seems that most of the works agree in affirming that exercise and diet supplementation are the cornerstones of rehabilitation treatment of patients with sarcopenia. The practice of an adequate lifestyle received numerous high-grade recommendations in the included guidelines. Based on the data obtained, the rehabilitation management of the patient with sarcopenia must be personalized and must include exercise and nutritional supplementation. These factors are important in increasing the autonomy of the elderly essential for safe walking without neglecting stretching exercises that are important for flexibility and balance and coordination exercises.

Association of Physical Activity and Physical Functioning Phenotypes With Fall Risk Among Women

Objective: Physical activity (PA) may slow aging-related declines in physical functioning (PF), but the relationship of PA and falls is not well understood. This study examined the association of PA and PF with falls. Methods: The Study of Women's Health Across the Nation participants (n = 1597; age: 65.1 years ± 2.7) reported PF and PA in 2012-2013 and falls in 2016-2017. Four phenotypes were identified: high PA-high PF, high PA-low PF, low PA-high PF, and low PA-low PF. Results: One-third (29.3%) reported ≥1 fall. Women with low PA-low PF (RR = 1.32; 95% CI: 1.06, 1.66) and with high PA-low PF (RR = 1.37; 95% CI: 1.07, 1.74) were more likely to fall than high PA-high PF. Over time, women with worsening PF had increased fall risk (RR = 1.43; 95% CI: 1.17, 1.74), but women who increased PA did not. Discussion: Poor PF increases the risk of falls, regardless of PA. However, increasing PA does not necessarily increase fall risk, reinforcing the importance of PA engagement.

Evaluation of Light Physical Activity Measured by Accelerometry and Mobility Disability During a 6-Year Follow-up in Older Women

IMPORTANCE

Almost 1 in 4 women older than 65 years is unable to walk 2 to 3 blocks, and mobility disability is a key factor associated with loss of independence. Lack of moderate to vigorous-intensity physical activity is associated with mobility disability, but whether lighter physical activity is associated with mobility disability is unknown.

OBJECTIVE

To determine the association of light-intensity physical activity and incident mobility disability among older women.

DESIGN, SETTING, AND PARTICIPANTS

This prospective cohort study included women enrolled in the Objectively Measured Physical Activity and Cardiovascular Health study, an ancillary study of the Women's Health Initiative, between March 2012 and April 2014, with follow-up through March 31, 2018. The Women's Health Initiative was a population-based, multisite study that recruited from 40 clinical sites across the US. Participants in the present analysis included 5735 of 7058 ambulatory, community-dwelling women aged 63 years and older who returned an accelerometer with usable data, were free of mobility disability, and had follow-up data on mobility status. Data were analyzed from August 2018 to May 2019.

EXPOSURES

Light-intensity physical activity, defined as movement requiring energy expenditure between 1.6 and 2.9 metabolic equivalents, captured using an accelerometer over 7 days.

MAIN OUTCOMES AND MEASURES

Incident mobility disability, defined as the first self-reported inability to walk 1 block or up a flight of stairs at annual follow-up, and persistent incident mobility disability, defined as incident mobility loss that persisted through the end of follow-up.

RESULTS

A total of 5735 participants were included for primary analysis of all incident mobility disability (mean [SD] age, 78.5 [6.6] years [range, 63-97 years]; 2811 [49.0%] White participants). Compared with women in the lowest quartile of light-intensity physical activity, lower risk of incident mobility disability was observed in quartile 2 (multivariable hazard ratio [HR], 0.78; 95% CI, 0.67-0.90), quartile 3 (HR, 0.60; 95% CI, 0.51-0.71), and quartile 4 (HR, 0.60; 95% CI, 0.51-0.71) (P < .001). This beneficial association was stronger for persistent mobility disability in quartile 2 (multivariable HR, 0.72; 95% CI, 0.60-0.85), quartile 3 (HR, 0.55; 95% CI, 0.46-0.67), and quartile 4 (HR, 0.52; 95% CI, 0.42-0.63) (P < .001). Stratified analyses showed the association was stronger among women with a body mass index of less than 30.0 (HR, 0.73; 95% CI, 0.66-0.82) compared with women with a body mass index of 30.0 or higher (HR, 0.91; 95% CI; 0.79-1.04; P = .04 for interaction).

CONCLUSIONS AND RELEVANCE

In this cohort study, increased time spent in light-intensity physical activity was associated with reduced incident mobility disability. These findings support placing greater emphasis on promoting light-intensity physical activity for preserving mobility in later life.

Impact of Malnutrition Status on Muscle Parameter Changes over a 5-Year Follow-Up of Community-Dwelling Older Adults from the SarcoPhAge Cohort

This study aimed to assess the impact of malnutrition on the 5-year evolution of physical performance, muscle mass and muscle strength in participants from the SarcoPhAge cohort, consisting of community-dwelling older adults. The malnutrition status was assessed at baseline (T0) according to the “Global Leadership Initiatives on Malnutrition” (GLIM) criteria, and the muscle parameters were evaluated both at T0 and after five years of follow-up (T5). Lean mass, muscle strength and physical performance were assessed using dual X-ray absorptiometry, handgrip dynamometry, the short physical performance battery test and the timed up and go test, respectively. Differences in muscle outcomes according to nutritional status were tested using Student’s t-test. The association between malnutrition and the relative 5-year change in the muscle parameters was tested using multiple linear regressions adjusted for several covariates. A total of 411 participants (mean age of 72.3 ± 6.1 years, 56% women) were included. Of them, 96 individuals (23%) were diagnosed with malnutrition at baseline. Their muscle parameters were significantly lower than those of the well-nourished patients both at baseline and after five years of follow-up (all p-values < 0.05), except for muscle strength in women at T5, which was not significantly lower in the presence of malnutrition. However, the 5-year changes in muscle parameters of malnourished individuals were not significantly different than those of well-nourished individuals (all p-values > 0.05).

Effects of physical activity in muscle ultrasound evaluation of an older adult population – a pilot study

INTRODUCTION: Population aging has become an increasing challenge in society and inactive aging populations are especially challenging. OBJECTIVE: The main aim of this study is to conduct ultrasound evaluation of the effects of an intervention program on muscle architecture in older adults. METHODS: A total of thirty-four individuals of both sexes aged over 60 years were divided into two groups as follows: an intervention group (n = 18), who took part in a physical activity program for 8 weeks, three sessions per week, lasting approximately 20 min on each occasion, and a control group, whose members were encouraged to maintain their usual daily routines (outdoor aerobic exercise) (n = 16). Only six of the 18 participants from the intervention group were available for a second evaluation session. All the participants were submitted to bilateral quadriceps muscle ultrasound evaluations; thickness and echo-intensity of muscles were analyzed. RESULTS: Muscle thickness showed a significant negative correlation with age and echo-intensity showed a significant positive correlation with age. Echo-intensity showed a significant negative correlation with muscle thickness. Comparing the groups at the baseline evaluation, there were no significant differences between them (p < 0.05) for either measurement. CONCLUSIONS: We can highlight three points regarding post-intervention status in the intervention group: 1. There were significant differences in echo-intensity. It is therefore essential to establish early strategies to promote active aging, thus preventing dependence and inactivity in the older adult population; 2. Ultrasound is a good method for evaluating the musculoskeletal system and its changes in response to aging and physical activities; 3 Physical activities are important to maintain the muscles healthy and the older adult population independent.

Correlation Between the Distribution of Abdominal, Pericardial and Subcutaneous Fat and Muscle and Age and Gender in a Middle-Aged and Elderly Population

OBJECTIVE

The present study aimed to explore the relationships between the distribution of abdominal fat and muscle and age and gender in a middle-aged and elderly population.

METHODS

The levels of abdominal (visceral and subcutaneous) fat, pericardial fat, and psoas major muscle were measured in subjects who had physical examinations at the Health and Medical Department of Peking Union Medical College Hospital from July 2019 to June 2020. The relationship between fat in different areas (ie, different types of fat) and the relationship between different types of fat and the psoas major muscle were investigated in the context of different genders and ages.

RESULTS

The distribution of fat and muscle differed between males and females of the middle-aged and elderly study sample. Volumes of pericardial fat, total abdominal fat, and visceral fat were significantly lower in females than in males, and the area of the psoas major muscle was also significantly lower in females than in males. Levels of subcutaneous fat and total abdominal fat showed no significant correlation with age. The level of muscle showed a significant negative correlation with age.

CONCLUSION

1) Within the middle-aged and elderly sample, male subjects had higher levels than females of all types of fat except for abdominal subcutaneous fat, and had higher levels of psoas muscle than females. 2) Pericardial fat increased with age, whereas levels of abdominal fat did not change significantly with age. 3) The area of psoas major muscle appears to be positively correlated with volumes of all types of fat: subjects with more fat tended to have higher levels of psoas major muscle.

Can physical activity levels and relationships with energy expenditure change the clinical aspects of sarcopenia and perceptions of falls among elderly women? Observational cross-sectional study

BACKGROUND

Physical activity (PA) is an effective strategy for managing sarcopenia in the elderly, but few studies have addressed PA levels regarding age-related changes.

OBJECTIVE

To ascertain the effects of elderly women's PA levels on sarcopenia, physical performance, handgrip strength and perception of the risk of falling, and their relationship with energy expenditure.

DESIGN AND SETTING

Observational cross-sectional study conducted in the southern region of the city of São Paulo, Brazil.

METHODS

Forty-seven elderly women were evaluated and divided into three groups: low PA (n = 13); moderate PA (n = 16); and high PA (n = 18). Their PA levels were investigated through the International Physical Activity Questionnaire (IPAQ); sarcopenia index, through dual-energy radiological absorptiometry; physical performance through the Timed Up & Go test; handgrip strength, using a digital dynamometer; and perception of the risk of falling, through the Fall Risk Awareness Questionnaire.

RESULTS

High PA level indicated higher skeletal muscle mass index, physical performance and IPAQ score, compared with low and moderate PA levels. Multiple linear regression analysis showed that higher IPAQ energy expenditure at high and moderate PA levels was a good predictor of higher physical performance and increased perception of the risk of falling.

CONCLUSION

Elderly women classified as having high PA level showed improvements in sarcopenia, handgrip strength, physical performance and perception of the risk of falling. The IPAQ energy expenditure of the elderly women with high and moderate PA levels was a good predictor of physical performance and improved perception of the risk of falling.

Implications of Race and Ethnicity in Sarcopenia US National Prevalence of Sarcopenia by Muscle Mass, Strength, and Function Indices

Sarcopenia prevalence varies widely by definitions and populations, which led to the creation of new criteria by the Sarcopenia Definitions and Outcomes Consortium. Yet, the degree to which sarcopenia prevalence varies according to these criteria across race and ethnic groups in the U.S. population needs further investigation. We estimated the US national prevalence of sarcopenia using different indices among adults aged 50-80 years across race and ethnicity groups utilizing data from the National Health and Nutrition Examination Surveys (NHANES: 1999-2002 and 2011-2014). Sarcopenia was defined by appendicular lean mass divided by body mass index (ALM/BMI), grip strength, and gait speed. For each index the following samples were constructed: grip strength (NHANES 2011-2014: N=4,615), gait speed (NHANES 1999-2002: N=3,448) and ALM/BMI (NHANES 1999-2002: N=3,448) among adults aged 50-80 years. Sarcopenia prevalence varied by race/ethnicity: NH-Whites (11.2-24.3%), Hispanics (21.9-36.0%), NH-Blacks (4.4-27.7%), and Asians/others (18.5-35.7%). Based on the multivariable models, compared to NH-Whites, NH-Blacks were less likely to have sarcopenia by ALM/BMI (OR=0.26, 95%CI: 0.18-0.39), and more likely by gait speed (OR=3.90, 95% CI: 3.00-5.06) with no difference by grip strength (OR=0.96, 95%CI: 0.75-1.24). While, Hispanics and Asians/others were more likely to have sarcopenia by grip strength, gait speed, and ALM/BMI (ORs=2.15-3.21) compared to NH-Whites. This study suggests the need for inclusion of race/ethnicity related criteria in sarcopenia definitions. Future investigations could determine whether this discrepancy between race/ethnicity across sarcopenia indices, particularly in NH-Blacks, is partly due to either muscle mass or functional changes with aging.

Dietary inflammatory potential and risk of sarcopenia: data from national health and nutrition examination surveys

This study used National Health and Nutrition Examination Surveys data from 1999 to 2006 to investigate the association between dietary inflammatory potential, represented by dietary inflammatory index (DII) scores, and the risk of sarcopenia in U.S. adults. A total of 25,781 participants were included in the study. The DII scores were calculated based on dietary information collected from 24-hour recalls. Men and women were classified as sarcopenic if appendicular lean mass (ALM) adjusted for BMI (ALM_BMI) was <0.789 or <0.512, respectively. The covariates included comorbidities, dietary data, demographic data, and physical examination data. In a full-adjusted model, each unit of increase in DII score was associated with a 12% increase in risk of sarcopenia. When categorizing sarcopenia into tertiles, the adjusted effect size (relative to Tertile1) was 1.26 (95% CI, 1.07, 1.47) for Tertile 2 and 1.55 (95% CI, 1.31, 1.83) for Tertile 3. The trend test showed that the risk of sarcopenia increased with increasing DII tertiles, (P <0.0001). These findings demonstrate that dietary inflammatory potential correlates positively with the risk of sarcopenia and suggest that making ones diet inflammatory may reduce the incidence of sarcopenia and its associated negative health outcomes.

Age trajectories of disability in instrumental activities of daily living and disability-free life expectancy among middle-aged and older adults in Taiwan: an 11-year longitudinal study

BACKGROUND

This study aims to identify the age trajectories of disability in instrumental activities of daily life (IADLs) over 11 years and their correlates, and to estimate disability-free life expectancy for identified trajectory groups in middle-aged and older adults.

METHODS

We included 3118 participants aged 50 and over without IADL limitations at baseline from the Taiwan Longitudinal Study in Aging, followed across 1996-2007. We used group-based trajectory models to identify age trajectories of IADL disability, and multiple logistic regressions to examine their correlates. Sullivan method was used to compute IADL disability-free life expectancy for trajectory groups at different ages.

RESULTS

We identified two trajectories groups: 67.7% of participants classified as the late-onset group and 32.3% as the early-onset group. Female (adjusted odds ratio [aOR]: 1.93, 95% confidence interval [95% CI]: 1.54, 2.41), not being employed (aOR: 1.30, 95% CI: 1,08, 1,56), poor/fair self-rated health (aOR: 1.31, 95% CI:1.09, 1.58), hypertension (aOR: 1.32, 95% CI: 1.07, 1.63), diabetes mellitus (aOR: 2.29, 95% CI: 1.72, 3.07), arthritis (aOR: 1.42, 95% CI: 1.11, 1.81), stroke (aOR: 2.21, 95% CI: 1.04, 4.70), and one-point increase in a 10-item depression scale (aOR: 1.04, 95% CI: 1.02, 1.06) were associated with early-onset of disability, whereas higher education (aOR: 0.59, 95% CI: 0.42, 0.81), regular exercise (aOR: 0.76, 95% CI: 0.62, 0.93), and participating voluntary or club activities (aOR: 0.78, 95% CI: 0.65, 0.93) related to the late-onset. IADL disability-free life expectancies at 65 years old in the late-onset group were 15.6 years for women and 14.4 for men, respectively, comprising 56.6 and 64.2% of their remaining life, whereas those of the early-onset group were 4.8 and 4.6 years for women and men respectively, comprising 22.5 and 27.2% of remaining life.

CONCLUSIONS

Early-onset of IADLs disability may correlate to chronic conditions, and engagement in employment, exercise, and social participation were associated with a reduced risk of early disability in IADLs.

Functional tests associated with sarcopenia in moderate chronic obstructive pulmonary disease

Objectives: To evaluate the association of physical and functional measures with sarcopenia in moderate chronic obstructive pulmonary disease (COPD) and to establish cutoff points for sarcopenia screening.Methods: The study included COPD with and without sarcopenia, of both sexes who were over 50 years old. Participants were assessed for lung function, body composition, grip strength, Short Physical Performance Battery (SPPB), 5-repetition, 10-repetition and 30-s sit-to-stand tests (5STS, 10STS, and 30STS, respectively). In addition, 6-min walking test, respiratory muscular strength, and physical activity level were tested.Results: The study had 35 participants, 24 men (68.6%) and moderate COPD (51.4%). COPD-sarcopenia showed lower values in lean mass, body fat and body mass alongside lower performance in 10 and 30 STS tests, SPPB and gait speed compared to non-sarcopenic group. The cutoff points with better sensitivity and specificity to identify sarcopenia were 10.88 and 34.14 s, 15 repetitions, and 10 points in the 5STS, 10STS, 30STS, and SPPB, respectively. The comparison of the receiver operating curves evidenced no differences between the functional tests. Only 30STS and SPPB showed acceptable discriminatory power.Conclusion: Functional tests, especially 30STS and SPPB, are simple and affordable tools for screening sarcopenia in COPD with moderate obstruction.

Sarcopenia: Clinical implications in ovarian cancer, diagnosis, etiology, and management

Sarcopenia, loss of skeletal muscle and function, is a common condition among the elderly and is known to cause adverse health outcomes and increased risk of morbidity and mortality. This progressive and generalized disorder imposes a considerable socioeconomic burden. Sarcopenia is observed commonly in cancer patients. As Asia is one of the fastest aging regions in the world, it is clear that incidences of both sarcopenia and ovarian cancer will increase together in Asian countries. Ovarian cancer patients are vulnerable to develop sarcopenia during the treatment course and progress of disease, and a considerable number of patients with ovarian cancer seems to have physical inactivity and sarcopenia already at the time of diagnosis. Therefore, management of sarcopenia should be conducted together in parallel with ovarian cancer treatment and surveillance. Thus, in this article, we will review the clinical importance of sarcopenia in the aspect of ovarian cancer. Definition of sarcopenia, diagnosis, etiology, and intervention will be also introduced.

Prevalence, diagnostic criteria, and factors associated with sarcopenic obesity in older adults from a low middle income country: A systematic review

OBJECTIVE

To evaluate the scientific evidences on the prevalence, diagnostic criteria, and factors related to sarcopenic obesity (SO) in Brazilian older adults.

METHODS

this systematic review was based on searches of the databases PubMed, Science Direct, Excerpta Medica Database (Embase), Web of Science, Scientific Electronic Library Online (SciELO), and Scopus. The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The inclusion criteria were: original articles of observational design that evaluated the presence of sarcopenic obesity in Brazilian older adults (≥60 years). Therefore, studies that investigated only obesity or sarcopenia, animal studies, review studies, congress publications, theses, dissertations, book chapters, editorials, letters to the editor, and newspaper articles were not included.

RESULTS

The initial screening identified 549 records. After removing the duplicates, assessing the titles and abstracts, and the complete analysis of the papers, 12 studies were included in the review. The sample size of the studies ranged from 56 to 1373 subjects, most of them selected by convenience sampling (n = 11) and exclusively with women (n = 9). The prevalence of SO varied from 4.4% to 48.4%. No consensus was found on the diagnostic criteria for SO. The main associations identified were between SO and decrease in muscle strength, aerobic fitness, gait speed, and increase in frequency of frailty and cardiometabolic and inflammatory alterations.

CONCLUSIONS

Epidemiological studies conducted so far in Brazil are heterogeneous, which limits the possibility of comparison between prevalence and distribution of sarcopenic obesity among older adults. Further studies with representative samples of the population are required to understand the magnitude of SO in this group.

High Salt Diet Impacts the Risk of Sarcopenia Associated with Reduction of Skeletal Muscle Performance in the Japanese Population

The World Health Organization has recommended 5 g/day as dietary reference intakes for salt. In Japan, the averages for men and women were 11.0 g/day and 9.3 g/day, respectively. Recently, it was reported that amounts of sodium accumulation in skeletal muscles of older people were significantly higher than those in younger people. The purpose of this study was to investigate whether the risk of sarcopenia with decreased muscle mass and strength was related to the amount of salt intake. In addition, we investigated its involvement with renalase. Four groups based on age and salt intake ("younger low-salt," "younger high-salt," "older low-salt," and "older high-salt") were compared. Stratifying by age category, body fat percentage significantly increased in high-salt groups in both younger and older people. Handgrip strength/body weight and chair rise tests of the older high-salt group showed significant reduction compared to the older low-salt group. However, there was no significant difference in renalase concentrations in plasma. The results suggest that high-salt intake may lead to fat accumulation and muscle weakness associated with sarcopenia. Therefore, efforts to reduce salt intake may prevent sarcopenia.

Prevalence and risk factors of primary sarcopenia in community-dwelling outpatient elderly: a cross-sectional study

No previous study has investigated the prevalence and risk factors for primary sarcopenia in outpatient setting. This study aims to evaluate the prevalence and factors associated with primary sarcopenia in outpatient elderly. Additionally, we compared the severity of sarcopenia based on the 2014 and 2019 Asian Working Group for Sarcopenia (AWGS) criteria. This cross-sectional study was performed in 330 subjects aged over 60 years in an outpatient setting. The muscle strength, muscle performance and muscle mass were assessed using the handheld dynamometer, 6-m gait speed, and bioelectrical impedance analysis, respectively. The prevalence of sarcopenia was 10% as per the 2014 and 2019 AWGS criteria. The development of sarcopenia was positively correlated with the age with an odds ratio (OR) of 6.87 [95% confidence interval (CI) 1.63–28.88] in the middle-old group (70–79 years), and 13.71 (95%CI 3.66–51.41; p = 0.009) in the very old group (≥ 80 years). Prefrailty and low physical activity were significantly associated with sarcopenia with an OR of 4.75 (95%CI 1.90—11.89) in prefrailty, 15.35 (95%CI 1.69–139.47) in the middle activity group, and 17.99 (95%CI 1.95–165.73) in the lowest activity group. In conclusion, primary sarcopenia was found in one-tenth of outpatient elderly. Age, prefrailty, and low activity were independent factors associated with sarcopenia.

Prevalence and risk factors of sarcopenia in community-dwelling older adults visiting regional medical institutions from the Kadoma Sarcopenia Study

This study aimed to investigate risk factors for sarcopenia in community-dwelling older adults visiting regional medical institutions. We retrospectively analyzed medical records of 552 participants (mean age: 74.6 ± 6.7 years, males 31.3%) who underwent body composition evaluation between March 2017 and December 2018 at one of 24 medical institutions belonging to the Kadoma City Medical Association in Japan. We collected the participant's characteristics and laboratory data. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019. Sarcopenia, including severe sarcopenia, was detected in 22.3% of all participants, 17.3% of men, and 24.5% of women; rates increased with age. Multivariate logistic regression analysis revealed age (odds ratio [OR]: 2.12; 95% confidence interval [CI] 1.20-3.75), obesity (OR: 0.15; 95% CI 0.07-0.32), hypertension (OR: 0.44; 95% CI 0.25-0.76), certification of long term care (OR: 3.32; 95% CI 1.41-7.81), number of daily conversations (OR: 0.44; 95% CI 0.25-0.77), and malnutrition (OR: 2.42; 95% CI 1.04-5.60) as independent predictors of sarcopenia. Receiver operating characteristic curve analysis demonstrated that the cut-off for daily conversations defining sarcopenia was 4.8 persons. The prevalence of sarcopenia in this study was 22.3%. Besides traditional risk factors for sarcopenia, the number of daily conversations was an independent factor.

Soluble Whey Protein Hydrolysate Ameliorates Muscle Atrophy Induced by Immobilization via Regulating the PI3K/Akt Pathway in C57BL/6 Mice

Sarcopenia, a loss of skeletal muscle mass and function, is prevalent in older people and associated with functional decline and mortality. Protein supplementation is necessary to maintain skeletal muscle mass and whey protein hydrolysates have the best nutrient quality among food proteins. In the first study, C57BL/6 mice were subjected to immobilization for 1 week to induce muscle atrophy. Then, mice were administered with four different whey protein hydrolysates for 2 weeks with continuous immobilization. Among them, soluble whey protein hydrolysate (WP-S) had the greatest increase in grip strength, muscle weight, and cross-sectional area of muscle fiber than other whey protein hydrolysates. To investigate the molecular mechanism, we conducted another experiment with the same experimental design. WP-S significantly promoted the phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt)/mammalian target of rapamycin (mTOR) pathway and inhibited the PI3K/Akt/forkhead box O (FoxO) pathway. In addition, it increased myosin heavy chain (MyHC) expression in both the soleus and quadriceps and changed MyHC isoform expressions. In conclusion, WP-S attenuated muscle atrophy induced by immobilization by enhancing the net protein content regulating muscle protein synthesis and degradation. Thus, it is a necessary and probable candidate for developing functional food to prevent sarcopenia.

Effects of protein supplementation on muscle wasting disorders: A brief update of the evidence

OBJECTIVE

To examine the effects of protein supplementation on muscle mass, strength and function in individuals at risk of muscle wasting disorders.

METHODS

A narrative overview of the literature based on a PubMed search.

RESULTS

Increasing protein intake beyond the recommended dietary intake may prevent or attenuate muscle loss in people at risk of muscle wasting disorders; however, there is inconsistent evidence for any benefits on muscle strength or physical function. This is likely due to the significant heterogeneity and bias regarding baseline demographics, basal protein/energy intakes and protein supplement type, dose, timing and compliance.

CONCLUSION

Protein supplementation attenuates muscle loss in some populations at increased risk of muscle wasting, but there is no consistent evidence to support benefits on muscle strength or physical function. Further randomised controlled trials are needed that focus on whether there is an optimal type, dose and timing of protein intake, and potential interaction with other nutrients.

Association between Sarcopenia and Physical Function among Preoperative Lung Cancer Patients

We aimed to investigate the prevalence of sarcopenia using new diagnostic criteria and association of sarcopenia with cardiopulmonary function and physical activity (PA) in preoperative lung cancer patients. The data of 614 patients were obtained from the CATCH-LUNG cohort study. Patients were classified into three groups-normal (n = 520), pre-sarcopenia (n = 60, low skeletal muscle mass index only), and sarcopenia (n = 34, low SMI and strength). Cardiopulmonary function was measured using the 6-min walk test (6MWT), and PA was objectively measured using a wearable device. The adjusted odds ratio (aOR) for a <400-m distance in 6MWT was 3.52 (95% confidence interval (CI) 1.34-9.21) and 6.63 (95% CI 2.25-19.60) in the pre-sarcopenia and sarcopenia groups, respectively, compared to that in the normal group. The aOR (95% CI) for <5000 steps/day was 1.64 (0.65-4.16) and 4.20 (1.55-11.38) in the pre-sarcopenia and sarcopenia groups, respectively, compared to that in the normal group. In conclusion, the prevalence of pre-sarcopenia and sarcopenia was 9.8% and 5.5%, respectively, among preoperative lung cancer patients. Cardiopulmonary function and physical activity were significantly lower in the pre-sarcopenia and sarcopenia groups than in the normal group. Patients with sarcopenia had more robust findings, suggesting the importance of muscle strength and mass.

Effects of vibration therapy on muscle mass, muscle strength and physical function in older adults with sarcopenia: a systematic review and meta-analysis

Background

Sarcopenia, a progressive loss of muscle mass and function with advancing age, is a prevalent condition among older adults. As most older people are too frail to do intensive exercise and vibration therapy has low risk and ease of participation, it may be more readily accepted by elderly individuals. However, it remains unclear whether vibration therapy would be effective among older adults with sarcopenia. This systematic review and meta-analysis examined the effect of vibration therapy including local vibration therapy and whole-body vibration therapy, for enhancing muscle mass, muscle strength and physical function in older people with sarcopenia.

Methods

A systematic literature search was conducted in March 2019 in the following 5 electronic databases: PubMed, CINAHL, Embase, PEDro, and the Cochrane Central Register of Controlled Trials, with no restriction of language or the year of publication. Randomized controlled trials and quasi-experimental studies examining effects of vibration therapy on muscle mass, muscle strength or physical function in older adults with sarcopenia were included in this systematic review. Two reviewers independently assessed the methodological quality of the selected studies.

Results

Of the 1972 identified studies, seven publications from six studies involving 223 participants were included in this systematic review. Five of them conducted whole-body vibration therapy, while two conducted local vibration therapy. A meta-analysis of randomized controlled studies indicated that muscle strength significantly increased after whole-body vibration therapy (SMD 0.69, 95% CI 0.28 to 1.11, I² = 0%, P = 0.001) and local vibration therapy (SMD 3.78, 95% CI 2.29 to 5.28, P < 0.001). Physical performance measured by the sit-to-stand test and the timed-up-and-go test were significantly improved after the intervention (SMD -0.79, 95% CI − 1.21 to − 0.37, I² = 0%, P < 0.001) and SMD -0.83, 95% CI − 1.56 to − 0.11, I² = 64%, P = 0.02, respectively).

Conclusion

Vibration therapy could be a prospective strategy for improving muscle strength and physical performance in older adults with sarcopenia. However, due to the limited number of the included studies, caution is needed when interpreting these results. More well-designed, large sample size studies should be conducted to further explore and validate the benefits of vibration therapy for this population.

Preserving Mobility in Older Adults with Physical Frailty and Sarcopenia: Opportunities, Challenges, and Recommendations for Physical Activity Interventions

One of the most widely conserved hallmarks of aging is a decline in functional capabilities. Mobility loss is particularly burdensome due to its association with negative health outcomes, loss of independence and disability, and the heavy impact on quality of life. Recently, a new condition, physical frailty and sarcopenia, has been proposed to define a critical stage in the disabling cascade. Physical frailty and sarcopenia are characterized by weakness, slowness, and reduced muscle mass, yet with preserved ability to move independently. One of the strategies that have shown some benefits in combatting mobility loss and its consequences for older adults is physical activity. Here, we describe the opportunities and challenges for the development of physical activity interventions in people with physical frailty and sarcopenia. The aim of this article is to review age-related physio(patho)logical changes that impact mobility in old age and to provide recommendations and procedures in accordance with the available literature.

Sex Differences in People Aging With HIV

BACKGROUND

To evaluate differences between older women and men with HIV regarding HIV variables, comorbidity, physical function, and quality of life (QOL).

SETTING

The Modena HIV clinic.

METHODS

Prospective cohort study. Cross-sectional analysis. Patients >50 years were included, stratified by sex. We recorded sociodemographic data, comorbidities, variables related to HIV infection, frailty, data on body composition, physical function, physical activity, and QOL.

RESULTS

We evaluated 1126 older adults with HIV, of which 284 (25.2%) were women. Median age was 55 (IQR 6) years. There were significant differences between women and men in the median current CD4 T-cell and the mean CD4/CD8 ratio. There were differences regarding alcohol consumption, cardiovascular (CV) disease, hypertension, diabetes mellitus, and renal failure. Sarcopenia and slower gait speed were found more prevalent among men, but without significant differences. Significant differences were found regarding lower extremity strength measured by the chair stand test and in the short physical performance battery score. Short physical performance battery <9 was detected for 11.1% women vs. 5.6% men (P = 0.002). EQ5D5L score was 0.87 in women vs. 0.89 in men (P = 0.002).

CONCLUSIONS

In our cohort, older women represented one in 4 of the total patients. Despite the fact that women have better immunological recovery measured by CD4 T-cell count and CD4/CD8 ratio, and fewer CV disease and CV risk factors than men, their physical function and their QOL are worse. Therefore, older HIV-infected women have special characteristics, and the assessment of physical function in this group seems to be crucial.

Overspeed Stimulus Provided by Assisted Jumping Encourages Rapid Increases in Strength and Power Performance of Older Adults

Following a 4-week control period, 24 older men and women (55-91 years) attended a 4-week progressive jumping program to determine whether assisted jumping could be safely and effectively implemented as a novel stimulus in healthy older adults. Bodyweight countermovement jump performance, isometric and isokinetic strength, postural stability, and exercise enjoyment were assessed before the control period, before the training intervention, and after the training intervention. Following the 4-week intervention, eccentric quadriceps strength increased by 19 N·m (95% confidence interval [2, 36], p = .013), bodyweight countermovement jump height increased by 1.7 cm (95% CI [0.5, 2.9], p < .001), postural sway improved by 2.1 mm/s (95% CI [0.3, 4.0], p = .026), and the participants' perceived exercise enjoyment improved (p = .026). Therefore, using assisted jumping to induce an overspeed training stimulus in a jump training program resulted in similar performance improvements as in previous studies in older populations but with less training volume and a shorter training duration.

Muscle Hypertrophy and Architectural Changes in Response to Eight-Week Neuromuscular Electrical Stimulation Training in Healthy Older People

Loss of muscle mass of the lower limbs and of the spine extensors markedly impairs locomotor ability and spine stability in old age. In this study, we investigated whether 8 w of neuromuscular electrical stimulation (NMES) improves size and architecture of the lumbar multifidus (LM) and vastus lateralis (VL) along with locomotor ability in healthy older individuals. Eight volunteers (aged 65 ≥ years) performed NMES 3 times/week. Eight sex- and age-matched individuals served as controls. Functional tests (Timed Up and Go test (TUG) and Five Times Sit-to-Stand Test (FTSST)), VL muscle architecture (muscle thickness (MT), pennation angle (PA), and fiber length (FL)), along with VL cross-sectional area (CSA) and both sides of LM were measured before and after by ultrasound. By the end of the training period, MT and CSA of VL increased by 8.6% and 11.4%, respectively. No significant increases were observed in FL and PA. LM CSA increased by 5.6% (left) and 7.1% (right). Interestingly, all VL architectural parameters significantly decreased in the control group. The combined NMES had a large significant effect on TUG (r = 0.50, p = 0.046). These results extend previous findings on the hypertrophic effects of NMES training, suggesting to be a useful mean for combating age-related sarcopenia.

Physical activity and sarcopenia in older adults

BACKGROUND

Sarcopenia is prevalent in ever growing older adult populations.

AIM

The aim of this study was to quantify the association between physical activity (PA), sedentary time (SED), cardiorespiratory fitness (CRF), and strength (STR) with sarcopenia in community-dwelling older adults using a standard definition of sarcopenia.

METHOD

This cross-sectional study examined a large group of older adults (n = 304) who provided a broad range of health, lifestyle, and socioeconomic variables. PA was assessed using a pedometer worn for 7 days. SED was assessed by survey. CRF was assessed by 400-m walk test performance. Strength (STR) was assessed by one-repetition maximum chest and leg press. The European Working Group on Sarcopenia in Older People (EWGSOP) definition defined 10.9% (n = 33) as sarcopenic.

RESULTS

PA, CRF, and STR were significantly associated with sarcopenia components (muscle mass, muscle strength, and muscle function). The upper two-thirds of CRF had significantly lower odds of having sarcopenia, whereas the strongest third of STR was associated with lower odds of sarcopenia. All exposure variables had significant odds ratios associated with at least one component of sarcopenia. Joint analyses indicated additional benefit may be gained from being both active (≥ 5000 daily steps) and fit (top two-thirds), active and strong (top two-thirds), and fit and strong.

DISCUSSION

Overall, objectively measured PA, CRF, and STR, and self-reported SED, are associated with sarcopenia and its components.

CONCLUSION

Therefore, older adults who are physically active, maintain higher levels of cardiorespiratory fitness, upper and lower body strength, and avoid sedentary time may have significantly lower odds of sarcopenia.

Prevalence of probable sarcopenia in community-dwelling older Swiss people - a cross-sectional study

BACKGROUND

The European Working Group on Sarcopenia in Older People has recently defined new criteria for identifying "(probable) sarcopenia" (EWGSOP2). However, the prevalence of probable sarcopenia, defined by these guidelines, has not been determined extensively, especially in the oldest old. This study aims to determine the prevalence of probable sarcopenia in older, community-living people and its association with strength-related determinants.

METHODS

Handgrip strength and reported determinants (age, height, weight, osteoarthritis of hands, medications, fall history, physical activity, activities of daily living (ADL) and global cognitive function) were collected in a cross-sectional study of 219 community-living Swiss people (75 years and over). Probable sarcopenia was estimated based on cut-off values for handgrip strength as recommended by EWGSOP2. Spearman correlations, binary-regression analyses and contingency tables were used to explore relationships between variables.

RESULTS

The prevalence of probable sarcopenia in women (n = 137, age 84.1 ± 5.7 years) and men (n = 82, age 82.6 ± 5.2 years) was 26.3 and 28.0%, respectively. In women, probable sarcopenia correlated positively with age and falls (rs range 0.332-0.195, p < .05), and negatively with weight, cognition, physical activity, using stairs regularly, participating in sports activities and ADL performance (rs range = - 0.141 - -0.409, p < .05). The only significant predictor of probable sarcopenia at the multivariate level was ADL performance (Wald(1) = 5.51, p = .019). In men, probable sarcopenia was positively correlated with age (rs = 0.33, p < .05) and negatively with physical activity, participation in sports and ADL performance (rs range - 0.221 - - 0.353, p < .05). ADL performance and age (Wald(1) = 4.46, p = .035 and Wald(1) = 6.30, p = .012) were the only significant predictors at the multivariate level. Men and women with probable sarcopenia were 2.8 times more likely to be dependent in ADL than those without.

CONCLUSION

Probable sarcopenia affected one in every four community-living, oldest old people and was independently associated with impaired ADL performance in both sexes. This highlights the importance of detection of handgrip strength in this age group in clinical practice. Although prospective studies are required, independence in ADL might help to protect against probable sarcopenia.

Effects of an mHealth Brisk Walking Intervention on Increasing Physical Activity in Older People With Cognitive Frailty: Pilot Randomized Controlled Trial

BACKGROUND

Cognitive frailty is the coexistence of physical frailty and cognitive impairment and is an at-risk state for many adverse health outcomes. Moderate-to-vigorous physical activity (MVPA) is protective against the progression of cognitive frailty. Physical inactivity is common in older people, and brisk walking is a feasible form of physical activity that can enhance their MVPA. Mobile health (mHealth) employing persuasive technology has been successful in increasing the levels of physical activity in older people. However, its feasibility and effects on older people with cognitive frailty are unclear.

OBJECTIVE

We aimed to identify the issues related to the feasibility of an mHealth intervention and the trial (ie, recruitment, retention, participation, and compliance) and to examine the effects of the intervention on cognitive function, physical frailty, walking time, and MVPA.

METHODS

An open-label, parallel design, randomized controlled trial (RCT) was employed. The eligibility criteria for the participants were age ≥60 years, having cognitive frailty, and having physical inactivity. In the intervention group, participants received both conventional behavior change intervention and mHealth (ie, smartphone-assisted program using Samsung Health and WhatsApp) interventions. In the control group, participants received conventional behavior change intervention only. The outcomes included cognitive function, frailty, walking time, and MVPA. Permuted block randomization in 1:1 ratio was used. The feasibility issue was described in terms of participant recruitment, retention, participation, and compliance. Wilcoxon signed-rank test was used to test the within-group effects in both groups separately.

RESULTS

We recruited 99 participants; 33 eligible participants were randomized into either the intervention group (n=16) or the control (n=17) group. The median age was 71.0 years (IQR 9.0) and the majority of them were females (28/33, 85%). The recruitment rate was 33% (33/99), the participant retention rate was 91% (30/33), and the attendance rate of all the face-to-face sessions was 100% (33/33). The majority of the smartphone messages were read by the participants within 30 minutes (91/216, 42.1%). ActiGraph (58/66 days, 88%) and smartphone (54/56 days, 97%) wearing compliances were good. After the interventions, cognitive function improvement was significant in both the intervention (P=.003) and the control (P=.009) groups. The increase in frailty reduction (P=.005), walking time (P=.03), step count (P=.02), brisk walking time (P=.009), peak cadence (P=.003), and MVPA time (P=.02) were significant only in the intervention group.

CONCLUSIONS

Our mHealth intervention is feasible for implementation in older people with cognitive impairment and is effective at enhancing compliance with the brisk walking training program delivered by the conventional behavior change interventions. We provide preliminary evidence that this mHealth intervention can increase MVPA time to an extent sufficient to yield clinical benefits (ie, reduction in cognitive frailty). A full-powered and assessor-blinded RCT should be employed in the future to warrant these effects.

TRIAL REGISTRATION

HKU Clinical Trials Registry HKUCTR-2283; http://www.hkuctr.com/Study/Show/31df4708944944bd99e730d839db4756.

Indicators of Sarcopenia: Sex Differences in Competitive Runners Prior to Peak Muscle Mass

Strength, muscle mass, and muscle quality have been observed to be compromised in low body-mass index individuals such as competitive runners, increasing their risk for sarcopenia. The purpose was to compare indices of sarcopenia in young runners to age, height, body-mass, and body-mass index-matched non-runners. Handgrip strength and arm composition from dual-energy x-ray absorptiometry (baseline-T1, T2=5.3±1.4, T3=11.5±0.7 months later) were assessed in 40 non-runners and 40 runners (19.3±0.7 vs. 19.2±1.1 years, 170.7±10.3 vs. 171.1±9.1 cm, 60.2±7.4 vs. 60.2±7.9 kg, 20.6±0.9 vs. 20.5±1.5 kg m^-2). The unitless variable of muscle quality, was defined as the sum of right and left maximal handgrip (in kg) divided by the sum of bone-free lean mass of both arms (in kg). Female runners displayed the highest muscle quality (T1=15.3±1.7; T3=15.7±2.0) compared to male runners (T1=13.7±1.4, p < 0.001; T3=14.2±1.6, p < 0.001) and male non-runners (T1=12.4±1.8, p=0.001; T3=13.2±1.6, p < 0.001), while female non-runners (T1=14.6±2.5, p=0.154; T3=15.1 ±2.2, p=0.124) showed higher muscle quality than male non-runners. Higher muscle quality in low-body-mass index females persists over one-year during young-adulthood and while running contributes to whole-body muscle mass accrual, it does not appear to be significantly associated with improvements in the most commonly used upper-body diagnostic indicator of sarcopenia.

Optimizing Skeletal Muscle Anabolic Response to Resistance Training in Aging

Loss of muscle mass and strength with aging, also termed sarcopenia, results in a loss of mobility and independence. Exercise, particularly resistance training, has proven to be beneficial in counteracting the aging-associated loss of skeletal muscle mass and function. However, the anabolic response to exercise in old age is not as robust, with blunted improvements in muscle size, strength, and function in comparison to younger individuals. This review provides an overview of several physiological changes which may contribute to age-related loss of muscle mass and decreased anabolism in response to resistance training in the elderly. Additionally, the following supplemental therapies with potential to synergize with resistance training to increase muscle mass are discussed: nutrition, creatine, anti-inflammatory drugs, testosterone, and growth hormone (GH). Although these interventions hold some promise, further research is necessary to optimize the response to exercise in elderly patients.

Relationship of vitamin D receptor gene polymorphism with sarcopenia and muscle traits based on propensity score matching

Background

Vitamin D receptor (VDR) gene polymorphism is reported to be associated with muscle mass and muscle strength. Loss of skeletal muscle mass and decreased muscle strength are the main characteristics of sarcopenia. In this study, the relationship of VDR gene polymorphism with muscle traits (muscle mass, muscle strength, and physical performance) and sarcopenia were studied in Xinjiang, China.

Methods

Totally, 205 sarcopenia patients were enrolled. Propensity score method was used to match control group. FokI and BsmI polymorphisms were genotyped using improved multiplex ligation detection reaction (iMLDR).

Results

Fok1, but not Bsm1, polymorphism was significantly associated with sarcopenia. Patients with Fok1 GG genotype were more likely to have sarcopenia. Both Bsm1 and Fok1 polymorphism were related to muscle traits. Patients with Bsm1 CT genotype had lower gait speed (GS) but higher skeletal mass index. Patients with Fok1 GG genotype had lower GS, and female subjects with the Fok1 GG genotype had lower handgrip strength (HS). GS was decreased in Bsm1 CT genotype than CC carriers. HS and GS were decreased in Fok1 GG genotype than AA carriers.

Conclusion

Fok1, but not Bsm1, polymorphism is associated with sarcopenia. Both Bsm1 and Fok1 polymorphism affect both HS and GS.

Preserved Capacity for Adaptations in Strength and Muscle Regulatory Factors in Elderly in Response to Resistance Exercise Training and Deconditioning

Aging is related to an inevitable loss of muscle mass and strength. The mechanisms behind age-related loss of muscle tissue are not fully understood but may, among other things, be induced by age-related differences in myogenic regulatory factors. Resistance exercise training and deconditioning offers a model to investigate differences in myogenic regulatory factors that may be important for age-related loss of muscle mass and strength. Nine elderly (82 ± 7 years old) and nine young, healthy persons (22 ± 2 years old) participated in the study. Exercise consisted of six weeks of resistance training of the quadriceps muscle followed by eight weeks of deconditioning. Muscle biopsy samples before and after training and during the deconditioning period were analyzed for MyoD, myogenin, insulin-like growth-factor I receptor, activin receptor IIB, smad2, porin, and citrate synthase. Muscle strength improved with resistance training by 78% (95.0 ± 22.0 kg) in the elderly to a similar extent as in the young participants (83.5%; 178.2 ± 44.2 kg) and returned to baseline in both groups after eight weeks of deconditioning. No difference was seen in expression of muscle regulatory factors between elderly and young in response to exercise training and deconditioning. In conclusion, the capacity to gain muscle strength with resistance exercise training in elderly was not impaired, highlighting this as a potent tool to combat age-related loss of muscle function, possibly due to preserved regulation of myogenic factors in elderly compared with young muscle.

Assisted Jumping in Healthy Older Adults: Optimizing High-Velocity Training Prescription

Tufano, JJ, Vetrovsky, T, Stastny, P, Steffl, M, Malecek, J, and Omcirk, D. Assisted jumping in healthy older adults: optimizing high-velocity training prescription. J Strength Cond Res XX(X): 000-000, 2020-Because older adults benefit from power training, training strategies for athletes such as supramaximal velocity-assisted jumping could also be useful for older adults. However, optimizing-assisted exercise prescription in older adults remains uninvestigated. Therefore, the purpose of this study was to determine the effects of different bodyweight (BW) assistance levels on jumping force and velocity in healthy older adults. Twenty-three healthy older adults (67.6 ± 7.6 years, 167.0 ± 8.8 cm, 72.7 ± 14.3 kg, and 27.1 ± 6.9% body fat) performed 5 individual countermovement jumps at BW, 90, 80, 70, and 60% of BW. Jumps were performed on a force plate, which provided peak take-off force (TOF), flight time, and peak impact force. A linear position transducer measured peak concentric velocity (PV). The rating of perceived exertion (RPE) was also assessed after each condition. Take-off force was greater during BW than all other conditions, 90 and 80% were greater than 70 and 60%, but there were no differences between 80 and 90% or between 70 and 60%. The FT progressively increased at all assistance levels, and PV was faster for all assistance levels than BW, with no differences between assistance levels. Impact force was greater during BW than 80, 70, and 60% and was greater during 90% than 60%. The RPE was less than BW during all assistance conditions but was the least during 70%. Implementing assisted jumping between 70 and 80% of BW in older adults likely provides the ideal combination of force, velocity, and RPE.

[Lipid-Lowering Therapy for Primary Cardiovascular Prevention in Older Adults. Consensus Statement of the Russian Association of Gerontologists and Geriatricians, National Society on Atherosclerosis, Russian Society of Cardiology, Association of Clinical Pharmacologists]

 Completed randomized clinical studies did not have a sufficient statistical power for demonstrating clearly the efficacy of lipid-lowering therapy for primary prevention in patients aged 75 years and older and did not evaluate the effect of lipid-lowering therapy on development and course of key geriatric syndromes. Age-related alterations of skeletal muscles, cognitive decline, senile asthenia, comorbidities, polypragmasy, potential changes in drug pharmacokinetics and pharmacodynamics, and impaired renal function may adversely affect the benefit to harm ratio of statins in older patients. Key questions for administration of a lipid-lowering therapy for primary prevention in patients aged 75 years and older are: 1. Does the relationship between increased low-density lipoprotein cholesterol (LDL CS) and death rate persist? 2. Does a benefit from decreasing the level of LDL CS persist? 3. Is the lipid-lowering therapy safe? 4. What scales for risk stratification and determining indications for lipid-lowering therapy should be used?

The potential long-term impact of the COVID-19 outbreak on patients with non-communicable diseases in Europe: consequences for healthy ageing

The early stages of the COVID-19 pandemic have focused on containing SARS-CoV-2 infection and identifying treatment strategies. While controlling this communicable disease is of utmost importance, the long-term effect on individuals with non-communicable diseases (NCD) is significant. Although certain NCDs appear to increase the severity of COVID-19 and mortality risk, SARS-CoV-2 infection in survivors with NCDs may also affect the progression of their pre-existing clinical conditions. Infection containment measures will have substantial short- and long-term consequences; social distancing and quarantine restrictions will reduce physical activity and increase other unhealthy lifestyles, thus increasing NCD risk factors and worsening clinical symptoms. Vitamin D levels might decrease and there might be a rise in mental health disorders. Many countries have made changes to routine management of NCD patients, e.g., cancelling non-urgent outpatient visits, which will have important implications for NCD management, diagnosis of new-onset NCDs, medication adherence, and NCD progression. We may have opportunities to learn from this unprecedented crisis on how to leverage healthcare technologies and improve procedures to optimize healthcare service provision. This article discusses how the COVID-19 outbreak and related infection control measures could hit the most frail individuals, worsening the condition of NCD patients, while further jeopardizing the sustainability of the healthcare systems. We suggest ways to define an integrated strategy that could involve both public institutional entities and the private sector to safeguard frail individuals and mitigate the impact of the outbreak.

Nutrient and food group intakes and skeletal muscle index in the Japanese elderly: a cross-sectional analysis of the NHNS 2017

Objective:

To examine nutrient and food intakes according to the levels of skeletal muscle mass index (SMI) in the elderly.

Design:

Cross-sectional study.

Setting:

Data were derived from the 2017 National Health and Nutrition Survey in Japan. SMI was calculated by dividing appendicular skeletal muscle (or lean) mass (kg) by height squared (m2). We calculated the multivariable-adjusted means of individuals’ dietary intake. Dietary intake of energy, nutrients and food categories was assessed by examining dietary records using a semi-weighed method and compared according to the sex-specific quartiles of SMI.

Participants:

Men and women aged ≥60 years.

Results:

Among 797 men and 969 women, individuals with a higher SMI consumed more energy and more nutrients than did those with a lower SMI after adjusting for age, lifestyle and physical activity factors. After further adjusting for energy intake, total dietary fibre, vitamin A, vitamin B6, K, Fe and Cu were positively associated with higher SMI in men (Pfor trend < 0·05). For food categories, men with a higher SMI consumed more vegetables and meats, but the associations were attenuated after adjustment for energy and remained significant for vegetable only (Pfor trend = 0·018).

Conclusions:

Japanese elderly people with a higher SMI consumed more energy and nutrients and more vegetables than did those with a lower SMI. This finding shows that diet is important in preventing muscle loss among the elderly in an ageing society.

Hamid MS, Tan NC. The prevalence and factors associated with sarcopenia among community living elderly with type 2 diabetes mellitus in primary care clinics in Malaysia

Sarcopenia is a recognised geriatric syndrome but few studies address its associated factors among elderly with type 2 diabetes mellitus (T2DM) in South East Asia. This study aimed to determine the prevalence of sarcopenia and its associated factors among the elderly with T2DM in public primary care clinics in Malaysia. This study utilised data from a longitudinal study of 506 adults with T2DM aged ≥60 years. Data on socio-demography, clinical and functional status, diet and levels of physical activity (PA) were collected. Sarcopenia was defined using Asian Working Group for Sarcopenia criteria and its associated factors were analysed using multiple logistic regression. The proportion of elderly with T2DM with sarcopenia was 28.5%. Those aged ≥70 years (β = 0.73;OR = 2.07; 95%CI = 1.24, 3.48; p = 0.006), men (β = 0.61; OR = 1.84; 95%CI = 1.12, 3.02; p = 0.017), with ≥10 years duration of diabetes (β = 0.62; OR = 1.85; 95%CI = 1.11, 3.09; p = 0.018), not using insulin sensitizers (β = -1.44; OR = 0.24; 95%CI = 0.08, 0.71; p = 0.010), using less than 5 medications (β = 0.68; OR = 1.98; 95%CI = 1.17, 3.36; p = 0.011), low body mass index (BMI) (β = -2.43; OR = 0.09; 95%CI = 0.05, 0.17; p<0.001), and engaging in low (β = 0.77; OR = 2.15; 95%CI = 1.07, 4.35; p = 0.032) and moderate physical activities (β = 0.80; OR = 2.23; 95%CI = 1.07, 4.66; p = 0.033) were associated with sarcopenia. Factors that predicts sarcopenia such as level of physical activity and body mass index were among the modifiable factors that could be used in developing future strategies to prevent or delay the progression of sarcopenia among elderly with T2DM to improve their health status.

Grape Polyphenols Ameliorate Muscle Decline Reducing Oxidative Stress and Oxidative Damage in Aged Rats

A large number of studies have demonstrated the implication of oxidative stress (OxS) in the pathogenesis of ageing-related muscle decline and atrophy. The key mechanism is related to the OxS-induced production of free radicals, with the consequent increase in oxidative damage, resulting in affected muscle quality and strength. The present study aimed to evaluate the efficacy of a grape polyphenol-based nutraceutical formulation (Taurisolo^®) in reducing the OxS in muscle of aged rats. A group of 16 aged (20 months) rats were orally administered with Taurisolo^® (n = 8; 100 mg/kg Taurisolo^®) or placebo (n = 8; 50 mg/kg maltodextrin); an additional group of eight young (three months) rats were also treated with placebo. All the treatments were orally administered for 30 days. The activities of antioxidant enzymes, the levels of malondialdehyde (MDA) and nitrotyrosine (N-Tyr) and the expression of OxS- and inflammation-related genes were evaluated on the gastrocnemius muscle. In muscle samples of the treated-group, increased activity of antioxidant enzymes, reduced MDA and N-Tyr levels and increased expression of antioxidant and anti-inflammatory genes were observed in respect to the placebo. Data herein presented suggest that the chronic treatment with Taurisolo^® significantly reduces oxidative damage and improves muscle performance in aged rats.

Interaction of recommended levels of physical activity and protein intake is associated with greater physical function and lower fat mass in older women: Kuopio Osteoporosis Risk Factor- (OSTPRE) and Fracture-Prevention Study

The aim of the study was to investigate whether the interaction of physical activity (PA) and protein intake is associated with physical function (PF). The women from the Osteoporosis Risk Factor and Fracture Prevention Study (n 610) completed a questionnaire on lifestyle factors and PA and underwent PF and body composition measurements at baseline (BL) and over 3 years of follow-up (3y-FU). PA was categorised according to WHO cut-off PA = 0, 0 < PA < 2·5 and PA ≥ 2·5 h/week. Protein intake was calculated from the 3-d food record at baseline and categorised according to the Nordic Nutrition Recommendations <1·1 and ≥1·1 g/kg body weight (BW). The results showed in univariate ANOVA at the baseline and at the 3-year follow-up, women with high PA ≥ 2·5 h/week and protein intake ≥ 1·1 g/kg BW had higher grip strength adjusted for BMI, higher mean number of chair rises, faster mean walking speed, higher modified mean short physical performance battery score and lower mean fat mass compared with other interaction groups. High PA and protein intake were associated with lower BMI despite significantly higher energy intake. In conclusion, higher PA and protein intake interaction was associated with greater PF and lower fat mass, but the association with relative skeletal muscle index and muscle mass was inconclusive. The present study gives noteworthy information for preventing sarcopenia.

Estimation of Dietary Amino Acid Intake and Independent Correlates of Skeletal Muscle Mass Index among Korean Adults

The aim of this study was to develop a database to identify dietary amino acid intake levels, and to determine whether any amino acid groups were independently correlated with skeletal muscle mass index (SMI). We used data from the Korea National Health and Nutrition Examination Survey 2008–2011, and a total of 3292 participants aged 50–64 years were included in the analysis. Dietary data were obtained using the 24 h recall method. Data regarding dietary amino acid intake was assessed using the computer-aided nutritional analysis program 4.0 published by the Korean Nutrition Society. Multivariate linear regression analysis was used to identify independent correlates of SMI. The major food group that contributed the highest essential amino acid intake was grain and grain products (histidine 25.5%, isoleucine 43.9%, leucine 44.2%, methionine 31.0%, phenylalanine 44.8%, tryptophan 26.4%, and valine 50.8%). Higher SMI was independently associated with sex (men), lower age and body mass index, higher levels of physical activity, and a higher intake of energy and branched-chain amino acids. These results are expected to be used as a basis for developing dietary amino acid intake guidelines for Koreans.

Influence of combined vitamin D3 supplementation and resistance exercise training on musculoskeletal health in older men and women (EXVITD): protocol for a randomised controlled trial

INTRODUCTION

Sarcopenia is a progressive loss in muscle mass, strength and function, the adverse consequences of which are severe, affecting quality of life and placing an increasing burden on social and healthcare systems. Vitamin D status is known to be associated with markers of sarcopenia, namely muscle mass, strength and function. Also, resistance exercise training (RET) is currently the only proven intervention to treat sarcopenia. However, very little data exist on the influence of combining the two interventions of vitamin D supplementation and resistance exercise training, although a recent systematic review provides tentative support for the current study's hypothesis that the combined intervention may further improve musculoskeletal function above exercise training alone. The aim of the present study is to determine whether vitamin D3 supplementation is any more effective in improving musculoskeletal function when combined with RET compared with exercise training alone in older adults.

METHODS AND ANALYSIS

This double-blinded randomised placebo-controlled trial will recruit a target of 127 eligible men and women aged ≥65 years living independently or in sheltered housing within the Birmingham area to two groups: (1) 6 months RET and placebo or (2) 6 months RET and 800 IU/d vitamin D3. Measures of muscle power (Nottingham Power Rig), body composition (dual energy X-ray absorptiometry), muscle function (short physical performance battery, timed up and go), falls and fractures as events will be assessed. Assessments will take place at baseline and postintervention, with intermittent monitoring of bone turnover, calcium and vitamin D. The primary outcome will be lower limb extensor power output. Analyses of within-group changes and between-group differences in outcome measures are planned.

ETHICS AND DISSEMINATION

The EXVITD study has ethical approval granted by the Black Country National Health Service Research Ethics Committee (14/WM/1220). Results of this trial will be submitted for publication in peer-reviewed journals and presented at conferences. The study is being conducted according to the principles of the Declaration of Helsinki.Trial registration numberNCT02467153; Post-results.

Evaluation of Prevalence of the Sarcopenia Level Using Machine Learning Techniques: Case Study in Tijuana Baja California, Mexico

The article presents a study based on timeline data analysis of the level of sarcopenia in older patients in Baja California, Mexico. Information was examined at the beginning of the study (first event), three months later (second event), and six months later (third event). Sarcopenia is defined as the loss of muscle mass quality and strength. The study was conducted with 166 patients. A total of 65% were women and 35% were men. The mean age of the enrolled patients was 77.24 years. The research included 99 variables that consider medical history, pharmacology, psychological tests, comorbidity (Charlson), functional capacity (Barthel and Lawton), undernourishment (mini nutritional assessment (MNA) validated test), as well as biochemical and socio-demographic data. Our aim was to evaluate the prevalence of the level of sarcopenia in a population of chronically ill patients assessed at the Tijuana General Hospital. We used machine learning techniques to assess and identify the determining variables to focus on the patients’ evolution. The following classifiers were used: Support Vector Machines, Linear Support Vector Machines, Radial Basis Function, Gaussian process, Decision Tree, Random Forest, multilayer perceptron, AdaBoost, Gaussian Naive Bayes, and Quadratic Discriminant Analysis. In order of importance, we found that the following variables determine the level of sarcopenia: Age, Systolic arterial hypertension, mini nutritional assessment (MNA), Number of chronic diseases, and Sodium. They are therefore considered relevant in the decision-making process of choosing treatment or prevention. Analysis of the relationship between the presence of the variables and the classifiers used to measure sarcopenia revealed that the Decision Tree classifier, with the Age, Systolic arterial hypertension, MNA, Number of chronic diseases, and Sodium variables, showed a precision of 0.864, accuracy of 0.831, and an F1 score of 0.900 in the first and second events. Precision of 0.867, accuracy of 0.825, and an F1 score of 0.867 were obtained in event three with the same variables. We can therefore conclude that the Decision Tree classifier yields the best results for the assessment of the determining variables and suggests that the study population’s sarcopenia did not change from moderate to severe.

The Association Between Sedentary Behavior and Sarcopenia Among Adults Aged ≥65 Years in Low- and Middle-Income Countries

The present study aimed to assess the association between sedentary behavior and sarcopenia among adults aged ≥65 years. Cross-sectional data from the Study on Global Ageing and Adult Health were analyzed. Sarcopenia was defined as having low skeletal muscle mass and either a slow gait speed or a weak handgrip strength. Self-reported sedentary behavior was assessed as a continuous variable (hours per day) and also as a categorical variable (0-<4, 4-<8, 8-<11, ≥11 hours/day). Multivariable logistic regression was conducted to assess the association between sedentary behavior and sarcopenia. Analyses using the overall sample and country-wise samples were conducted. A total of 14,585 participants aged ≥65 years were included in the analysis. Their mean age was 72.6 (standard deviation, 11.5) years and 55% were females. Compared to sedentary behavior of 0-<4 hours/day, ≥11hours/day was significantly associated with 2.14 (95% CI = 1.06-4.33) times higher odds for sarcopenia. The country-wise analysis showed that overall, a one-hour increase in sedentary behavior per day was associated with 1.06 (95% CI = 1.04-1.10) times higher odds for sarcopenia, while the level of between-country heterogeneity was low (I2 = 12.9%). Public health and healthcare practitioners may wish to target reductions in sedentary behavior to aid in the prevention of sarcopenia in older adults.