Sarcopenia and physical activity in older male cardiac patients

A Narrative Review of the Diagnosis and Treatment of Sarcopenia and Malnutrition in Patients with Heart Failure

The prevalence of sarcopenia (loss of muscle strength, mass and function) in individuals with heart failure (HF) stands at a considerable level (approximately 20%), contributing to heightened mortality rates and diminished quality of life. The underlying pathophysiological mechanisms involve the presence of low-grade inflammation and a disturbance of the anabolic-catabolic protein balance. The nutritional assessment of patients with HF is a key aspect, and diverse diagnostic tools are employed based on patient profiles (outpatient, inpatient and nursing home). The Global Leadership Initiative on Malnutrition (GLIM) criteria serves as a consensus for diagnosing malnutrition. Given that edema can impact body mass index (BMI) in patients with HF, alternative body assessment technical methods, such as bioelectrical vector impedance (BiVA), BIA (without vector mode), computer tomography (CT) or clinical ultrasound (US), are useful. Scientific evidence supports the efficacy of both aerobic and resistance physical exercises in ameliorating and preventing muscle wasting associated with HF. Dietary strategies emphasize the importance of protein intake, while certain micronutrients like coenzyme Q10 or intravenous iron may offer benefits. This narrative review aims to present the current understanding of the pathogenesis, diagnosis and treatment of muscle loss in individuals with heart failure and its consequential impact on prognosis.

Differential association between physical activity behaviours and dynapenia by comorbid diseases in community-dwelling Korean older adults

BACKGROUND

Physical activity (PA) behaviours and comorbid diseases are associated with muscle strength. However, the association between dynapenia and detailed PA behaviours, including participation in aerobic and resistance exercises and sedentary behaviour (SB), in relation to comorbid diseases has not yet been investigated. Using nationwide data, this study aimed to evaluate the independent association of dynapenia with detailed PA behaviour (participation in aerobic and resistance exercises and SB), and assess the differential associations of detailed PA behaviour with dynapenia according to comorbid diseases with prevalent sarcopenia.

METHODS

A total of 7,558 community-dwelling older adults aged ≥ 65 years who were included in the Korea National Health and Nutrition Examination Survey from 2014 to 2019 were included in the present study. Cross-sectional associations between PA behaviours (participation in aerobic exercise, participation in resistance exercise, and SB) and dynapenia were analysed using complex-sample multivariable-adjusted logistic regression models according to the type of comorbid disease (cardiovascular disease [CVD], diabetes mellitus [DM], and chronic lung disease [CLD]).

RESULTS

Sufficient aerobic exercise, sufficient resistance exercise, and low sedentary time of < 420 min/day showed independent negative associations with dynapenia (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.60-0.83; OR, 0.54; 95% CI, 0.42-0.69; and OR, 0.84; 95% CI, 0.72-0.97, respectively). Among the participants with CVD or CLD, the associations of sufficient resistance exercise (OR, 0.46; 95% CI, 0.26-0.82 and OR, 0.51; 95% CI, 0.35-0.75 for CVD and CLD, respectively) and low sedentary time (OR, 0.66; 95% CI, 0.45-0.98 and OR, 0.71; 95% CI, 0.55-0.93 for CVD and CLD, respectively) with dynapenia were significant, whereas the association of sufficient aerobic exercise with dynapenia was insignificant. Meanwhile, in participants with DM, sufficient aerobic exercise (OR, 0.70; 95% CI, 0.52-0.94) and sufficient resistance exercise (OR, 0.45; 95% CI, 0.29-0.70) were independently associated with dynapenia, whereas no association between SB and dynapenia was found.

CONCLUSION

We observed an independent inverse association between PA behaviours and dynapenia. Disease-specific associations between each PA behaviour (sufficient aerobic exercise, sufficient resistance exercise, and low sedentary time) and dynapenia differed in the older adults. Therefore, these differences should be acknowledged during interventions for this population.

Prevalence and Impact of Sarcopenia in Heart Failure: A Cross-Sectional Study

Background:

Abnormal structure and function of cardiac muscles in heart failure (HF) may lead to decreased muscle mass and muscle strength, including low physical performance. This may play an important role in the development of sarcopenia.

Objective:

The objectives of this study were to determine the prevalence of sarcopenia among patients with HF and to explore the association between sarcopenia and HF.

Methods:

A cross-sectional study of 152 patients with HF was conducted in Thammasat University Hospital and Central Chest Institute of Thailand. Sarcopenia was defined according to the Asian Working Group for Sarcopenia. Participants were requested to perform handgrip strength, gait speed, and muscle mass. Logistic regression analysis was used to examine the association between sarcopenia occurrence and HF.

Results:

The prevalence of sarcopenia in patients with HF was 19.8% (14.0% in men and 31.1% in women). Participants with sarcopenia had a significantly lower body mass index (BMI) than those without sarcopenia (p<0.001). In addition, patients with sarcopenia had significantly lower respiratory muscle strength than those without sarcopenia (p<0.01). Sarcopenia was found to be significantly associated with age, sex, BMI, and left ventricular ejection fraction (LVEF) (p<0.05). In addition, age, sex, BMI, and LVEF predicted skeletal muscle mass index (SMI) accounted for 76.8% of the variance.

Conclusion:

The prevalence of sarcopenia among patients with HF was similar to that reported in previous studies. Regarding risk factors, age, sex, BMI, and LVEF were related to sarcopenia in the female sex, advanced age, low BMI, and low LVEF.

Physical Activity and Sarcopenia in Community-Dwelling Older Adults with Long-Term Care Insurance

The present study aimed to clarify the difference in physical activity (PA) due to sarcopenia in community-dwelling older adults with long-term care insurance (LTCI). This was a cross-sectional study that investigated data of 97 consecutive community-dwelling older Japanese adults with LTCI who underwent rehabilitation at one day care center in Japan from November 2018 to May 2019. Sarcopenia was determined according to criteria of the Asian Working Group for Sarcopenia. Unpaired t-test, Mann-Whitney U test, chi-square test and analysis of covariance were used to compare participant characteristics and clinical parameters between the older adults with and without sarcopenia. A receiver operating characteristic (ROC) curve was constructed to determine the cut-off value of PA for sarcopenia. The sarcopenia group (n = 20) had significantly lower body mass index (BMI), skeletal muscle mass index, gait speed, and PA than those in the no sarcopenia group (n = 28) (p < 0.05). After adjustment for BMI and sex, the sarcopenia group showed significantly lower PA than the no sarcopenia group. Findings showed that the cut-off value of PA indicating sarcopenia by ROC curve analysis was 1494.4 steps/day (p < 0.05); this value may aid in identifying sarcopenia in older adults with LTCI.

Sarcopenia predicts adverse outcomes in an elderly population with coronary artery disease: a systematic review and meta-analysis

Background

The development of sarcopenia is attributed to normal aging and factors like type 2 diabetes, obesity, inactivity, reduced testosterone levels, and malnutrition, which are factors of poor prognosis in patients with coronary artery disease (CAD). This study aimed to perform a meta-analysis to assess whether preoperative sarcopenia can be used to predict the outcomes after cardiac surgery in elderly patients with CAD.

Methods

PubMed, Embase, the Cochrane library, and Web of Science were searched for available papers published up to December 2020. The primary outcome was major adverse cardiovascular outcomes (MACE). The secondary outcomes were mortality and heart failure (HF)-related hospitalization. The random-effects model was used. Hazard ratios (HRs) with 95% confidence intervals (95%CIs) were estimated.

Results

Ten studies were included, with 3707 patients followed for 6 months to 4.5 ± 2.3 years. The sarcopenia population had a higher rate of MACE compared to the non-sarcopenia population (HR = 2.27, 95%CI: 1.58–3.27, P < 0.001; I² = 60.0%, P_{heterogeneity} = 0.02). The association between sarcopenia and MACE was significant when using the psoas muscle area index (PMI) to define sarcopenia (HR = 2.86, 95%CI: 1.84–4.46, P < 0.001; I² = 0%, P_{heterogeneity} = 0.604). Sarcopenia was not associated with higher late mortality (HR = 2.15, 95%CI: 0.89–5.22, P = 0.090; I² = 91.0%, P_{heterogeneity} < 0.001), all-cause mortality (HR = 1.35, 95%CI: 0.14–12.84, P = 0.792; I² = 90.5%, P_{heterogeneity} = 0.001), and death, HF-related hospitalization (HR = 1.37, 95%CI: 0.59–3.16, P = 0.459; I² = 62.0%, P_{heterogeneity} = 0.105). The sensitivity analysis revealed no outlying study in the analysis of the association between sarcopenia and MACE after coronary intervention.

Conclusion

Sarcopenia is associated with poor MACE outcomes in patients with CAD. The results could help determine subpopulations of patients needing special monitoring after CAD surgery. The present study included several kinds of participants; although non-heterogeneity was found, interpretation should be cautious.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02438-w.

The Association between time spent in performing physical activity and physical function in outpatients with type 2 diabetes who may have diabetic neuropathy

AIMS

To determine the relationship between physical activity time and physical function according to the Japanese Clinical Practice Guideline for Diabetes, which recommended 150 min of activity for outpatients with type 2 diabetes who may have diabetic neuropathy.

METHODS

We examined a cross-sectional study with 79 outpatients with Type 2 diabetes participated. A short version, Japanese language edition of the International Physical Activity Questionnaire (IPAQ) was used to evaluate physical activity. Isometric knee extensor strength, grip strength, maximum 10-m walking speed, the Michigan Neuropathy Screening Instrument score, and the Short Physical Performance Battery (SPPB). Each evaluation item was compared between time spent performing physical activity ≥150 min group and <150 min group, and multiple regression analysis was performed to determine the factors associated with time spent performing physical activity. Further, the correlation between time spent performing physical activity and isometric knee extensor strength was examined.

RESULTS

The ≥150 min group had significantly higher isometric knee extensor strength than the <150 min group. In addition, the ≥150 min group had significantly faster maximum 10-m walking speed and sit-to-stand time than the <150 min group. Isometric knee extensor strength was determined to be an independent factor associated with the IPAQ score. A positive correlation was found between the IPAQ score and isometric knee extensor strength.

CONCLUSIONS

Among the patients with type 2 diabetes who may have diabetic neuropathy, those who performed physical activity for ≥150 min per week were suggested to have higher physical function than those with <150 min of activity.

Cachexia, muscle wasting, and frailty in cardiovascular disease

The last several years have seen increasing interest in understanding cachexia, muscle wasting, and physical frailty across the broad spectrum of patients with cardiovascular illnesses. This interest originally started in the field of heart failure, but has recently been extended to other areas such as atrial fibrillation, coronary artery disease, peripheral artery disease as well as to patients after cardiac surgery or transcatheter aortic valve implantation. Tissue wasting and frailty are prevalent among many of the affected patients. The ageing process itself and concomitant cardiovascular illness decrease lean mass while fat mass is relatively preserved, making elderly patients particularly prone to develop wasting syndromes and frailty. The aim of this review is to provide an overview of the available knowledge of body wasting and physical frailty in patients with cardiovascular illness, particularly focussing on patients with heart failure in whom most of the available data have been gathered. In addition, mechanisms of wasting and possible therapeutic targets are discussed.

Publication trends in cachexia and sarcopenia in elderly heart failure patients

The loss of skeletal mass - sarcopenia and cachexia - is considered to be a major contributor to morbidity and mortality in chronic heart failure (CHF). Unfortunately, sarcopenia is generally considered to be a geriatric syndrome, but not necessarily seen as a comorbidity in CHF, even though it has a wide range of adverse health outcomes. While there were 15,574 publication with the title word "heart failure" in PubMed in the 5‑year period from 1 June 2011 to 31 May 2016, only 22 or 71 publications were found with the search combination "sarcopenia" or "cachexia" (title word) and "heart failure" (all fields), respectively. This shows very clearly that loss of muscle quality and function due to heart failure is still an underappreciated problem in the medical field.