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Lee DY. Prevalence and Risk Factors for Hand-Grip-Determined Dynapenia in the Korean Population: A Cross-Sectional Study. Sports (Basel) 2024; 12:187. [PMID: 39058078 PMCID: PMC11281309 DOI: 10.3390/sports12070187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/03/2024] [Accepted: 07/04/2024] [Indexed: 07/28/2024] Open
Abstract
Dynapenia refers to muscle weakness related to aging and is defined as a loss of muscle strength associated with muscle quality. The purpose of this study is to identify the prevalence of dynapenia and associated risk factors by gender and age in domestic adults and to provide customized basic data for the prevention of dynapenia through its management. Based on the data from 2014 to 2019 of the Korea National Health and Nutrition Survey, 20,950 adults over the age of 20 who participated in grip strength tests and health surveys were selected as participants. Factors related to dynapenia were analyzed using complex sample multilogistic regression analysis. The prevalence of dynapenia in domestic adults was 6.3%, 4.1% in men, and 8.7% in women. Prevalence in the second decade was 5.3%, in the third decade was 3.2%, in the fourth decade was 3.3%, in the fifth decade was 4.8%, in the sixth decade was 8.9%, and was 24.6% for participants in their seventh decade or beyond. Among the factors related to dynapenia, age, BMI, and alcohol status were common in both men and women; education level, HDL-C, and resistance exercise were common in men; and high blood pressure, high blood sugar, and aerobic exercise were common in women. Our findings indicate that several factors are associated with dynapenia, which should be considered as potential targets for interventions focused on both individual and public health measures.
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Affiliation(s)
- Do-Youn Lee
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Gyeongsan 38453, Republic of Korea
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2
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Gusdon AM, Savarraj JPJ, Feng D, Starkman A, Li G, Bodanapally U, Zimmerman W, Ryan AS, Choi HA, Badjatia N. Identification of metabolites associated with preserved muscle volume after aneurysmal subarachnoid hemorrhage due to high protein supplementation and neuromuscular electrical stimulation. Sci Rep 2024; 14:15071. [PMID: 38956192 PMCID: PMC11219968 DOI: 10.1038/s41598-024-64666-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 06/11/2024] [Indexed: 07/04/2024] Open
Abstract
The INSPIRE randomized clinical trial demonstrated that a high protein diet (HPRO) combined with neuromuscular electrical stimulation (NMES) attenuates muscle atrophy and may improve outcomes after aneurysmal subarachnoid hemorrhage We sought to identify specific metabolites mediating these effects. Blood samples were collected from subjects on admission prior to randomization to either standard of care (SOC; N = 12) or HPRO + NMES (N = 12) and at 7 days. Untargeted metabolomics were performed for each plasma sample. Sparse partial least squared discriminant analysis identified metabolites differentiating each group. Correlation coefficients were calculated between each metabolite and total protein per day and muscle volume. Multivariable models determined associations between metabolites and muscle volume. Unique metabolites (18) were identified differentiating SOC from HPRO + NMES. Of these, 9 had significant positive correlations with protein intake. In multivariable models, N-acetylleucine was significantly associated with preserved temporalis [OR 1.08 (95% CI 1.01, 1.16)] and quadricep [OR 1.08 (95% CI 1.02, 1.15)] muscle volume. Quinolinate was also significantly associated with preserved temporalis [OR 1.05 (95% CI 1.01, 1.09)] and quadricep [OR 1.04 (95% CI 1.00, 1.07)] muscle volume. N-acetylserine and β-hydroxyisovaleroylcarnitine were associated with preserved temporalis or quadricep volume. Metabolites defining HPRO + NMES had strong correlations with protein intake and were associated with preserved muscle volume.
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Affiliation(s)
- Aaron M Gusdon
- Division of Neurocritical Care, Department of Neurosurgery, McGovern School of Medicine, University of Texas Health Science Center, Houston, TX, USA
| | - Jude P J Savarraj
- Division of Neurocritical Care, Department of Neurosurgery, McGovern School of Medicine, University of Texas Health Science Center, Houston, TX, USA
| | - Diana Feng
- Division of Neurocritical Care, Department of Neurosurgery, McGovern School of Medicine, University of Texas Health Science Center, Houston, TX, USA
| | - Adam Starkman
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Guoyan Li
- Division of Gerontology, Geriatric, and Palliative Medicine, Department of Medicine, Geriatric Research, Education, and Clinical Center (GRECC), University of Maryland School of Medicine, Baltimore, MD, USA
| | - Uttam Bodanapally
- Department of Radiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - William Zimmerman
- Program in Trauma, Shock Trauma Neurocritical Care and Department of Neurology, University of Maryland School of Medicine, 22 S. Greene Street, G7K19, Baltimore, MD, 21201, USA
| | - Alice S Ryan
- Division of Gerontology, Geriatric, and Palliative Medicine, Department of Medicine, Geriatric Research, Education, and Clinical Center (GRECC), University of Maryland School of Medicine, Baltimore, MD, USA
| | - Huimahn A Choi
- Division of Neurocritical Care, Department of Neurosurgery, McGovern School of Medicine, University of Texas Health Science Center, Houston, TX, USA
| | - Neeraj Badjatia
- Program in Trauma, Shock Trauma Neurocritical Care and Department of Neurology, University of Maryland School of Medicine, 22 S. Greene Street, G7K19, Baltimore, MD, 21201, USA.
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3
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Hyngstrom AS, Nguyen JN, Murphy SA, Raab SC, Schmit BD, Gutterman DD, Durand MJ. Reduced oxygen desaturation in the vastus lateralis of chronic stroke survivors during graded muscle contractions. Top Stroke Rehabil 2024; 31:513-526. [PMID: 38095272 PMCID: PMC11129930 DOI: 10.1080/10749357.2023.2291902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/02/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Few studies have examined changes in skeletal muscle physiology post-stroke. This study examined changes in tissue oxygen saturation (StO2) of the vastus lateralis (VL) muscle of stroke survivors and age-matched control participants during maximal and submaximal isometric contractions of the knee extensor muscles. OBJECTIVES We hypothesized that tissue oxygen desaturation (ΔStO2) during knee extensor muscle contractions would be less in the VL in the paretic vs. the non-paretic and control legs. METHODS Ten chronic stroke survivors (>6 months post-stroke) with lower extremity muscle weakness and 10 age-matched controls completed this prospective cohort study. Maximum voluntary contractions (MVCs) of the knee extensor muscles were assessed with a Biodex dynamometer and StO2 of the VL was measured using near-infrared spectroscopy. RESULTS In the paretic leg of the stroke survivors little change in StO2 of the VL was observed during an MVC (ΔStO2 = -1.7 ± 1.8%) compared to the non-paretic (ΔStO2 = -5.1 ± 6.1%; p < 0.05) and control legs (ΔStO2 = -14.4 ± 8.8%; p < 0.05 vs. paretic and non-paretic leg). These differences remained when normalizing for strength differences between the legs. Compared to controls, both the paretic and non-paretic VL showed pronounced reductions in ΔStO2 during ramp and hold contractions equal to 20%, 40%, or 60% of the MVC (p < 0.05 vs. controls at all load levels). CONCLUSIONS These results indicate that oxygen desaturation in response to isometric muscle contractions is impaired in both the paretic and non-paretic leg muscle of stroke survivors compared to age-matched controls, and these differences are independent of differences in muscle strength.
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Affiliation(s)
| | - Jennifer N. Nguyen
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, USA, 53226
| | - Spencer A. Murphy
- Department of Physical Therapy, Marquette University, Milwaukee, WI, USA, 53233
| | - Stephanie C. Raab
- Department of Physical Therapy, Marquette University, Milwaukee, WI, USA, 53233
| | - Brian D. Schmit
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, USA, 53226
| | - David D. Gutterman
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA, 53226
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA, 53226
| | - Matthew J. Durand
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, USA, 53226
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, USA, 53226
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4
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Hatzantonis C, Satkunam L, Rabey KN, Hocking JC, Agur AMR. Fatty infiltration of gastrocnemius-soleus muscle complex: Considerations for myosteatosis rehabilitation. J Anat 2024; 245:50-57. [PMID: 38361481 PMCID: PMC11161819 DOI: 10.1111/joa.14025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/17/2024] Open
Abstract
Although previous studies have reported fatty infiltration of the gastrocnemius-soleus complex, little is known about the volumetric distribution and patterns of fatty infiltration. The purpose of this anatomical study was to document and quantify the frequency, distribution, and pattern of fatty infiltration of the gastrocnemius-soleus complex. One hundred formalin-embalmed specimens (mean age 78.1 ± 12.3 years; 48F/52M) were serially dissected to document the frequency, distribution, and pattern of fatty infiltration in the medial and lateral heads of gastrocnemius and soleus muscles. Fatty infiltration was found in 23% of specimens, 13 unilaterally (8F/5M) and 10 (5M/5F) bilaterally. The fatty infiltration process was observed to begin medially from the medial aspect of the medial head of gastrocnemius and medial margin of soleus and then progressed laterally throughout the medial head of gastrocnemius and the marginal, anterior, and posterior soleus. The lateral head of gastrocnemius remained primarily muscular in all specimens. Microscopically, the pattern of infiltration was demonstrated as intramuscular with intact aponeuroses, and septa. The remaining endo-, peri-, and epimysium preserved the overall contour of the gastrocnemius-soleus complex, even in cases of significant fatty replacement. Since the external contour of the calf is preserved, the presence of fatty infiltration may be underdiagnosed in the clinic without imaging. Myosteatosis is associated with gait and balance challenges in the elderly, which can impact quality of life and result in increased risk of falling. The findings of the study have implications in the rehabilitation management of elderly patients with sarcopenia and myosteatosis.
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Affiliation(s)
| | - Lalith Satkunam
- Division of Physical Medicine and Rehabilitation, Department of MedicineGlenrose Rehabilitation Hospital, University of AlbertaEdmontonAlbertaCanada
| | - Karyne N. Rabey
- Division of Anatomy, Department of SurgeryUniversity of AlbertaEdmontonAlbertaCanada
| | - Jennifer C. Hocking
- Division of Anatomy, Department of SurgeryUniversity of AlbertaEdmontonAlbertaCanada
| | - Anne M. R. Agur
- Division of Anatomy, Department of SurgeryUniversity of TorontoTorontoOntarioCanada
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5
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Guo Y, Jones EJ, Smart TF, Altheyab A, Gamage N, Stashuk DW, Piasecki J, Phillips BE, Atherton PJ, Piasecki M. Sex disparities of human neuromuscular decline in older humans. J Physiol 2024. [PMID: 38857412 DOI: 10.1113/jp285653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 05/07/2024] [Indexed: 06/12/2024] Open
Abstract
Females typically live longer than males but, paradoxically, spend a greater number of later years in poorer health. The neuromuscular system is a critical component of the progression to frailty, and motor unit (MU) characteristics differ by sex in healthy young individuals and may adapt to ageing in a sex-specific manner due to divergent hormonal profiles. The purpose of this study was to investigate sex differences in vastus lateralis (VL) MU structure and function in early to late elderly humans. Intramuscular electromyography signals from 50 healthy older adults (M/F: 26/24) were collected from VL during standardized submaximal contractions and decomposed to quantify MU characteristics. Muscle size and neuromuscular performance were also measured. Females had higher MU firing rate (FR) than males (P = 0.025), with no difference in MU structure or neuromuscular junction transmission (NMJ) instability. All MU characteristics increased from low- to mid-level contractions (P < 0.05) without sex × level interactions. Females had smaller cross-sectional area of VL, lower strength and poorer force steadiness (P < 0.05). From early to late elderly, both sexes showed decreased neuromuscular function (P < 0.05) without sex-specific patterns. Higher VL MUFRs at normalized contraction levels previously observed in young are also apparent in old individuals, with no sex-based difference of estimates of MU structure or NMJ transmission instability. From early to late elderly, the deterioration of neuromuscular function and MU characteristics did not differ between sexes, yet function was consistently greater in males. These parallel trajectories underscore the lower initial level for older females and may offer insights into identifying critical intervention periods. KEY POINTS: Females generally exhibit an extended lifespan when compared to males, yet this is accompanied by a poorer healthspan and higher rates of frailty. In healthy young people, motor unit firing rate (MUFR) at normalized contraction intensities is widely reported to be higher in females than in age-matched males. Here we show in 50 people that older females have higher MUFR than older males with little difference in other MU parameters. The trajectory of decline from early to late elderly does not differ between sexes, yet function is consistently lower in females. These findings highlight distinguishable sex disparities in some MU characteristics and neuromuscular function, and suggest early interventions are needed for females to prevent functional deterioration to reduce the ageing health-sex paradox.
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Affiliation(s)
- Yuxiao Guo
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
- Centre of Metabolism, Ageing & Physiology (COMAP), MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Eleanor J Jones
- Centre of Metabolism, Ageing & Physiology (COMAP), MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Thomas F Smart
- Centre of Metabolism, Ageing & Physiology (COMAP), MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Abdulmajeed Altheyab
- Centre of Metabolism, Ageing & Physiology (COMAP), MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
- College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
| | - Nishadi Gamage
- Centre of Metabolism, Ageing & Physiology (COMAP), MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
- Neurophysiology of Human Movement Group, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Daniel W Stashuk
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Jessica Piasecki
- Musculoskeletal Physiology Research Group, Sport, Health and Performance Enhancement Research Centre, Nottingham Trent University, Nottingham, UK
| | - Bethan E Phillips
- Centre of Metabolism, Ageing & Physiology (COMAP), MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Philip J Atherton
- Centre of Metabolism, Ageing & Physiology (COMAP), MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Mathew Piasecki
- Centre of Metabolism, Ageing & Physiology (COMAP), MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
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6
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Ryan AS, Beamer BA, Gruber-Baldini AL, Craik RL, Golden J, Guralnik J, Hochberg MC, Mangione KK, Orwig D, Rathbun AM, Magaziner J. Effects of Multicomponent Home-Based Intervention on Muscle Composition, Fitness, and Bone Density After Hip Fracture. J Gerontol A Biol Sci Med Sci 2024; 79:glae078. [PMID: 38452133 PMCID: PMC11025556 DOI: 10.1093/gerona/glae078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Mechanistic factors on the pathway to improving independent ambulatory ability among hip fracture patients by a multicomponent home-based physical therapy intervention that emphasized aerobic, strength, balance, and functional training are unknown. The aim of this study was to determine the effects of 2 different home-based physical therapy programs on muscle area and attenuation (reflects muscle density) of the lower extremities, bone mineral density (BMD), and aerobic capacity. METHODS Randomized controlled trial of home-based 16 weeks of strength, endurance, balance, and function exercises (PUSH, n = 19) compared to seated active range-of-motion exercises and transcutaneous electrical neurostimulation (PULSE, n = 18) in community-dwelling adults >60 years of age within 26 weeks of hip fracture. RESULTS In PUSH and PULSE groups combined, the fractured leg had lower muscle area and muscle attenuation and higher subcutaneous fat than the nonfractured leg (p < .001) at baseline. At 16 weeks, mean muscle area of the fractured leg was higher in the PUSH than PULSE group (p = .04). Changes in muscle area were not significantly different when compared to the comparative PULSE group. There was a clinically relevant difference in change in femoral neck BMD between groups (p = .05) that showed an increase after PULSE and decrease after PUSH. There were generally no between-group differences in mean VO2peak tests at 16-week follow-up, except the PUSH group reached a higher max incline (p = .04). CONCLUSIONS The treatment effects of a multicomponent home-based physical therapy intervention on muscle composition, BMD, and aerobic capacity were not significantly different than an active control intervention in older adults recovering from hip fracture. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01783704.
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Affiliation(s)
- Alice S Ryan
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Medicine, Baltimore VAMC, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Geriatric Research, Education and Clinical Center (GRECC), VA Maryland Health Care System
| | - Brock A Beamer
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Medicine, Baltimore VAMC, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Geriatric Research, Education and Clinical Center (GRECC), VA Maryland Health Care System
| | - Ann L Gruber-Baldini
- Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Rebecca L Craik
- Department of Physical Therapy, College of Health Sciences, Arcadia University, Glenside, Pennsylvania, USA
| | - Justine Golden
- Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jack Guralnik
- Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Marc C Hochberg
- Department of Medicine, UMSOM and Medical Care Clinical Center, VA Maryland Health Care System, Baltimore, Maryland, USA
- Department of Epidemiology and Public Health, UMSOM and Medical Care Clinical Center, VA Maryland Health Care System, Baltimore, Maryland, USA
| | - Kathleen K Mangione
- Department of Physical Therapy, College of Health Sciences, Arcadia University, Glenside, Pennsylvania, USA
| | - Denise Orwig
- Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Alan M Rathbun
- Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jay Magaziner
- Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Qi H, Tian D, Luan F, Yang R, Zeng N. Pathophysiological changes of muscle after ischemic stroke: a secondary consequence of stroke injury. Neural Regen Res 2024; 19:737-746. [PMID: 37843207 PMCID: PMC10664100 DOI: 10.4103/1673-5374.382221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/30/2023] [Accepted: 06/01/2023] [Indexed: 10/17/2023] Open
Abstract
Sufficient clinical evidence suggests that the damage caused by ischemic stroke to the body occurs not only in the acute phase but also during the recovery period, and that the latter has a greater impact on the long-term prognosis of the patient. However, current stroke studies have typically focused only on lesions in the central nervous system, ignoring secondary damage caused by this disease. Such a phenomenon arises from the slow progress of pathophysiological studies examining the central nervous system. Further, the appropriate therapeutic time window and benefits of thrombolytic therapy are still controversial, leading scholars to explore more pragmatic intervention strategies. As treatment measures targeting limb symptoms can greatly improve a patient's quality of life, they have become a critical intervention strategy. As the most vital component of the limbs, skeletal muscles have become potential points of concern. Despite this, to the best of our knowledge, there are no comprehensive reviews of pathophysiological changes and potential treatments for post-stroke skeletal muscle. The current review seeks to fill a gap in the current understanding of the pathological processes and mechanisms of muscle wasting atrophy, inflammation, neuroregeneration, mitochondrial changes, and nutritional dysregulation in stroke survivors. In addition, the challenges, as well as the optional solutions for individualized rehabilitation programs for stroke patients based on motor function are discussed.
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Affiliation(s)
- Hu Qi
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Dan Tian
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Fei Luan
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Ruocong Yang
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Nan Zeng
- State Key Laboratory of Southwestern Chinese Medicine Resources, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
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8
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Holm PM, Blankholm AD, Nielsen JL, Bandholm T, Wirth W, Wisser A, Kemnitz J, Eckstein F, Schrøder HM, Wernbom M, Skou ST. Effects of neuromuscular control and strengthening exercises on MRI-measured thigh tissue composition and muscle properties in people with knee osteoarthritis - an exploratory secondary analysis from a randomized controlled trial. Semin Arthritis Rheum 2024; 65:152390. [PMID: 38340609 DOI: 10.1016/j.semarthrit.2024.152390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/19/2023] [Accepted: 01/18/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE To investigate the effects of adding strength training to neuromuscular control exercises on thigh tissue composition and muscle properties in people with radiographic-symptomatic knee osteoarthritis (KOA). METHODS In this exploratory secondary analysis of a randomized controlled trial, using a complete-case approach, participants performed 12 weeks of twice-weekly neuromuscular control exercise and patient education (NEMEX, n = 34) or NEMEX plus quadriceps strength training (NEMEX+ST, n = 29). Outcomes were MRI-measured inter- and intramuscular adipose tissue (InterMAT, IntraMAT), quadriceps muscle cross-sectional area (CSA), knee-extensor strength, specific strength (strength/lean CSA) and 30 s chair-stands. Between-group effects were compared using a mixed model analysis of variance. RESULTS At 12 weeks, responses to NEMEX+ST overlapped with NEMEX for all outcomes. Both groups reduced InterMAT (NEMEX+ST=25 %, NEMEX=21 %); between-group difference: 0.8cm2 (95 % CI: -0.1, 1.7). NEMEX+ST decreased IntraMAT (2 %) and NEMEX increased IntraMAT (4 %); between-group difference 0.1 %-points (-0.3, 0.5). Both groups increased quadriceps CSA and lean CSA (CSA minus IntraMAT), improved knee-extensor strength and specific strength, and improved chair-stand performance with a trend towards greater effects in NEMEX+ST. CONCLUSION Adding strength training to 12 weeks of neuromuscular control exercises provided largely similar effects to neuromuscular control exercises alone in decreasing InterMAT and IntraMAT, in improving knee-extensor strength, CSA and in improving performance-based function in KOA persons, with a trend towards greater effects with additional strength training. Notably, both groups substantially reduced InterMAT and improved specific strength (an index of muscle quality). Our hypothesis-generating work warrants exploration of the roles played by InterMAT and IntraMAT in exercise effects in KOA.
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Affiliation(s)
- Pætur M Holm
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Faculty of Health Sciences, University of the Faroe Islands, Tórshavn, Faroe Islands.
| | | | - Jakob L Nielsen
- Research Unit for Muscle Physiology and Biomechanics, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Thomas Bandholm
- Department of Orthopaedic Surgery & Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Denmark; Physical Medicine & Rehabilitation Research Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital - Amager and Hvidovre, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Wolfgang Wirth
- Department of Imaging and Functional Musculoskeletal Research, Institute of Anatomy and Cell Biology & Ludwig Boltzmann Institute of Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University Salzburg and Nuremberg, Salzburg, Austria; Chondrometrics GmbH, Freilassing, Germany
| | - Anna Wisser
- Department of Imaging and Functional Musculoskeletal Research, Institute of Anatomy and Cell Biology & Ludwig Boltzmann Institute of Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University Salzburg and Nuremberg, Salzburg, Austria; Chondrometrics GmbH, Freilassing, Germany
| | - Jana Kemnitz
- Department of Imaging and Functional Musculoskeletal Research, Institute of Anatomy and Cell Biology & Ludwig Boltzmann Institute of Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University Salzburg and Nuremberg, Salzburg, Austria
| | - Felix Eckstein
- Department of Imaging and Functional Musculoskeletal Research, Institute of Anatomy and Cell Biology & Ludwig Boltzmann Institute of Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University Salzburg and Nuremberg, Salzburg, Austria; Chondrometrics GmbH, Freilassing, Germany
| | - Henrik M Schrøder
- Department of Orthopedic Surgery, Næstved-Slagelse-Ringsted Hospitals, Næstved, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Mathias Wernbom
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Søren T Skou
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark; Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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9
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Gruneisen E, Kremer R, Duque G. Fat as a Friend or Foe of the Bone. Curr Osteoporos Rep 2024; 22:245-256. [PMID: 38416274 DOI: 10.1007/s11914-024-00864-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE OF REVIEW The objective of this review is to summarize the literature on the prevalence and diagnosis of obesity and its metabolic profile, including bone metabolism, focusing on the main inflammatory and turnover bone mediators that better characterize metabolically healthy obesity phenotype, and to summarize the therapeutic interventions for obesity with their effects on bone health. RECENT FINDINGS Osteoporosis and fracture risk not only increase with age and menopause but also with metabolic diseases, such as diabetes mellitus. Thus, patients with high BMI may have a higher bone fragility and fracture risk. However, some obese individuals with healthy metabolic profiles seem to be less at risk of bone fracture. Obesity has become an alarming disease with growing prevalence and multiple metabolic comorbidities, resulting in a significant burden on healthcare and increased mortality. The imbalance between increased food ingestion and decreased energy expenditure leads to pathological adipose tissue distribution and function, with increased secretion of proinflammatory markers and harmful consequences for body tissues, including bone tissue. However, some obese individuals seem to have a healthy metabolic profile and may not develop cardiometabolic disease during their lives. This healthy metabolic profile also benefits bone turnover and is associated with lower fracture risk.
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Affiliation(s)
- Elodie Gruneisen
- Division of Endocrinology & Metabolism, Department of Medicine, McGill University Health Centre, Montréal, QC, Canada
| | - Richard Kremer
- Division of Endocrinology & Metabolism, Department of Medicine, McGill University Health Centre, Montréal, QC, Canada
- Bone, Muscle & Geroscience Group, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Gustavo Duque
- Bone, Muscle & Geroscience Group, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
- Dr. Joseph Kaufmann Chair in Geriatric Medicine, Department of Medicine, McGill University, Montreal, QC, Canada.
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10
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Li M, Yin Y, Qin D. Treadmill training impacts the skeletal muscle molecular clock after ischemia stroke in rats. Heliyon 2024; 10:e27430. [PMID: 38509905 PMCID: PMC10951531 DOI: 10.1016/j.heliyon.2024.e27430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/22/2024] Open
Abstract
Objective Stroke is frequently associated with muscle mass loss. Treadmill training is considered the most effective treatment for sarcopenia. Circadian rhythms are closely related to exercise and have been extensively studied. The skeletal muscle has its molecular clock genes. Exercise may regulate skeletal muscle clock genes. This study evaluated the effects of early treadmill training on the skeletal muscle molecular clock machinery in rats with stroke and determined the relationship of these changes with exercise-induced improvements in skeletal muscle health. Materials and methods Overall, 168 Sprague-Dawley rats were included in this study. We established an ischemic stroke rat model of sarcopenia. Finally, 144 rats were randomly allocated to four groups (36 per group): normal, sham, middle cerebral artery occlusion, and training. Neurological scores, rotating rod test, body weight, muscle circumference, wet weight, and hematoxylin-eosin staining were assessed. Twenty-four rats were used for transcriptome sequencing. Gene and protein expressions of skeletal muscles, such as brain muscle arnt-like 1, period 1, and period 2, were measured by quantitative real-time polymerase chain reaction and enzyme-linked immunosorbent assays. Results Neurological function scores and rotating rod test results improved after treadmill training. Nine differentially expressed genes were identified by comparing the sham group with the hemiplegic side of the model group. Seventeen differentially expressed genes were identified between the hemiplegic and non-hemiplegic sides. BMAL1, PER1, and PER2 mRNA levels increased on both sides after treadmill training. BMAL1 expression increased, and PER1 expression decreased on both sides, whereas PER2 expression decreased on the hemiplegic side but increased on the non-hemiplegic side. Conclusion Treadmill training can mitigate muscle loss and regulate skeletal muscle clock gene expression following ischemic stroke. Exercise affects the hemiplegic side and has a positive regulatory effect on the non-hemiplegic side.
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Affiliation(s)
- Mai Li
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Kunming Medical University, No. 374, Fengning Street, Dianmian Road, 650101, Kunming, China
| | - Yong Yin
- Department of Rehabilitation Medicine, The Affiliated Hospital of Yunnan University, No. 176, Qingnian Road, 650021, Kunming, China
| | - Dongdong Qin
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, No. 1076 Yuhua Road, Chenggong District, 650500, Kunming, China
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11
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Arnal-Gómez A, Cortés-Amador S, Ruescas-Nicolau MA, Carrasco JJ, Pérez-Alenda S, Santamaría-Balfagón A, Sánchez-Sánchez ML. Assessing Stroke-Related Sarcopenia in Chronic Stroke: Identification of Clinical Assessment Tools-A Pilot Study. Biomedicines 2023; 11:2601. [PMID: 37892976 PMCID: PMC10604487 DOI: 10.3390/biomedicines11102601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 10/29/2023] Open
Abstract
Stroke-related sarcopenia has recently been defined as the muscle atrophy consequent to stroke and assessing it following the guidelines with simple clinical tools is crucial in chronic stroke survivors. The aim of this study was to determine the characteristics of patient-friendly instruments sarcopenia in a chronic stroke sample (SG) compared to non-stroke counterparts (CG). Each participant underwent a single assessment which consisted of: SARC-F questionnaire, assessment of muscle strength (hand grip and five-times sit-to-stand test, 5STS), the calf circumference (CC) of both legs, the short physical performance battery (SPPB), and the 10 m walk test. A total of 68 participants were included (SG, n = 34 and CG, n = 34). All variables showed statistical differences (p < 0.05) between the SG and the CG, except handgrip although it showed lower values for SG. The values of the 5STS (16.26 s) and the SPPB (7 points) were below to the cutoff values for the SG. The five-times sit-to-stand test, SPPB, and gait speed can lead clinicians to detect stroke-related sarcopenia. Maximum handgrip shows a trend of low values for men and women in the SG, however, CC did not detect sarcopenia in our sample.
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Affiliation(s)
- Anna Arnal-Gómez
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010 Valencia, Spain; (A.A.-G.); (M.-A.R.-N.); (J.J.C.); (S.P.-A.); (M.L.S.-S.)
| | - Sara Cortés-Amador
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010 Valencia, Spain; (A.A.-G.); (M.-A.R.-N.); (J.J.C.); (S.P.-A.); (M.L.S.-S.)
| | - Maria-Arantzazu Ruescas-Nicolau
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010 Valencia, Spain; (A.A.-G.); (M.-A.R.-N.); (J.J.C.); (S.P.-A.); (M.L.S.-S.)
| | - Juan J. Carrasco
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010 Valencia, Spain; (A.A.-G.); (M.-A.R.-N.); (J.J.C.); (S.P.-A.); (M.L.S.-S.)
| | - Sofía Pérez-Alenda
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010 Valencia, Spain; (A.A.-G.); (M.-A.R.-N.); (J.J.C.); (S.P.-A.); (M.L.S.-S.)
| | | | - M. Luz Sánchez-Sánchez
- Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010 Valencia, Spain; (A.A.-G.); (M.-A.R.-N.); (J.J.C.); (S.P.-A.); (M.L.S.-S.)
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12
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Lee SH, Choi H, Kim KY, Lee HS, Jung JM. Appendicular Skeletal Muscle Mass Associated with Sarcopenia as a Predictor of Poor Functional Outcomes in Ischemic Stroke. Clin Interv Aging 2023; 18:1009-1020. [PMID: 37427011 PMCID: PMC10329446 DOI: 10.2147/cia.s402548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 06/17/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose Several studies have examined the clinical impact of poststroke and stroke-related sarcopenia on stroke recovery. However, few studies have investigated the effect of sarcopenia detected shortly after stroke on functional prognosis. We predicted functional outcomes using early screening for sarcopenia in patients with acute ischemic stroke. We also examined the effect of sarcopenia detected shortly after stroke on functional prognosis. Patients and Methods Patients diagnosed with acute ischemic stroke within 2 days of symptom onset were consecutively enrolled at a tertiary university hospital. Appendicular skeletal muscle mass (ASM) was measured using dual-energy X-ray absorptiometry during early hospitalization. Sarcopenia was diagnosed based on low ASM and strength criteria of the Asian Working Group for Sarcopenia (AWGS) and European Working Group on Sarcopenia in Older People (EWGSOP2). The primary outcome was poor functional outcome, defined as a modified Rankin score of 4-6 and all-cause mortality at 3 months. Results Of the 653 patients, 214 (32.8%) and 174 (26.6%) had sarcopenia according to the AWGS and EWGSOP2 criteria, respectively. Irrespective of the definition, the sarcopenia group had a significantly higher proportion of patients with poor functional outcomes and all-cause mortality. Multivariate logistic regression analysis revealed that height-adjusted ASM was independently associated with poor functional outcomes (odds ratio: 0.61; 95% confidence interval: 0.40-0.91; P <0.005), and they were negatively correlated. However, the association between 3-month mortality, skeletal muscle mass, and sarcopenia was not sustained in multivariate analyses. Conclusion Height-adjusted ASM associated with sarcopenia is a potential predictor of poor functional outcomes at 3 months in patients with acute stroke. However, owing to the limitations of this study, further research is required to confirm these findings.
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Affiliation(s)
- Sang-Hun Lee
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Hangseok Choi
- Medical Science Research Center, Korea University College of Medicine, Seoul, South Korea
| | - Keon-Yeup Kim
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Hyung-Soo Lee
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
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13
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Gungor L, Arsava EM, Guler A, Togay Isikay C, Aykac O, Batur Caglayan HZ, Kozak HH, Aydingoz U, Topcuoglu MA. Determinants of in-hospital muscle loss in acute ischemic stroke - Results of the Muscle Assessment in Stroke Study (MASS). Clin Nutr 2023; 42:431-439. [PMID: 36805095 DOI: 10.1016/j.clnu.2023.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/10/2023] [Accepted: 01/23/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND & AIMS There is a change in the mass and composition of paretic and non-paretic skeletal muscles in the chronic phase of stroke. The multi-center, prospective, and observational Muscle Assessment in Stroke Study (MASS) was performed to evaluate the degree of muscle loss during the in-hospital acute stroke setting and determine factors contributing to this loss. METHODS Acute dysphagic ischemic stroke patients (n = 107) admitted to neuro-intensive care units were evaluated by computed tomography on days 1 and 14 after admission to determine the cross-sectional muscle area (CSMA) at the level of the mid-humerus, mid-thigh, and third lumbar vertebra. The percentage change in CSMA and variables associated with this change were evaluated by univariate and multivariate analyses. RESULTS There were significant reductions in CSMA in all the muscle groups analyzed; the most prominent change was observed in the arms (both: 14.2 ± 10.7%; paretic: 17.7 ± 11.6%; non-paretic: 10.1 ± 12.5%), followed by the muscles in the legs (both: 12.4 ± 8.7%; paretic: 12.9 ± 9.9%; non-paretic: 12.0 ± 9.3%) and L3-vertebra level (5.6 ± 9.8%) (P < 0.001 for all). Higher calorie (r = -0.378, P < 0.001) or protein (r = -0.352, P < 0.001) intake was negatively associated with the decrease in CSMA of upper extremities. A substantial protein (≥0.4 g/kg/d) or calorie (≥5 kcal/kg/d) gap between targeted or actual intake was related to a larger decrease in CSMA in all the anatomic regions (P ≤ 0.05 for all). Other significant predictors of muscle loss included history of diabetes mellitus, male sex, higher BMI, in-hospital infections, and the necessity for invasive mechanical ventilation. CONCLUSIONS There is a considerable degree of loss in the global muscle mass in acute ischemic stroke patients over a two-week period. Along with several factors, falling significantly behind the daily protein or calorie targets was related to the decrease in the muscle area. TRIAL REGISTRATION INFORMATION: clinicaltrials.gov identifier NCT03825419.
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Affiliation(s)
- Levent Gungor
- Department of Neurology, Ondokuz Mayis University, Samsun, Turkey
| | | | - Ayse Guler
- Department of Neurology, Ege University, Izmir, Turkey
| | | | - Ozlem Aykac
- Department of Neurology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | | | - Ustun Aydingoz
- Department of Radiology, Hacettepe University, Ankara, Turkey
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14
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Verceles AC, Serra M, Davis D, Alon G, Wells CL, Parker E, Sorkin J, Bhatti W, Terrin ML. Combining exercise, protein supplementation and electric stimulation to mitigate muscle wasting and improve outcomes for survivors of critical illness-The ExPrES study. Heart Lung 2023; 58:229-235. [PMID: 36473808 PMCID: PMC9992240 DOI: 10.1016/j.hrtlng.2022.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Neuromuscular electrical stimulation (NMES) with high protein supplementation (HPRO) to preserve muscle mass and function has not been assessed in ICU patients. We compared the effects of combining NMES and HPRO with mobility and strength rehabilitation (NMES+HPRO+PT) to standardized ICU care. OBJECTIVES To assess the effectiveness of combined NMES+HPRO+PT in mitigating sarcopenia as evidenced by CT volume and cross-sectional area when compared to usual ICU care. Additionally, we assessed the effects of the combined therapy on select clinical outcomes, including nutritional status, nitrogen balance, delirium and days on mechanical ventilation. METHODS Participants were randomized by computer generated assignments to receive either NMES+HPRO+PT or standard care. Over 14 days the standardized ICU care group (N = 23) received usual critical care and rehabilitation while the NMES+HPRO+PT group (N = 16) received 30 min neuromuscular electrical stimulation of quadriceps and dorsiflexors twice-daily for 10 days and mean 1.3 ± 0.4 g/kg body weight of high protein supplementation in addition to standard care. Nonresponsive participants received passive exercises and, once responsive, were encouraged to exercise actively. Primary outcome measures were muscle volume and cross-sectional area measured using CT-imaging. Secondary outcomes included nutritional status, nitrogen balance, delirium and days on mechanical ventilation. RESULTS The NMES+HPRO+PT group (N = 16) lost less lower extremity muscle volume compared to the standard care group (N = 23) and had larger mean combined thigh cross-sectional area. The nitrogen balance remained negative in the standard care group, while positive on days 5, 9, and 14 in the NMES+HPRO+PT group. Standard care group participants experienced more delirium than the NMES+HPRO+PT group. No differences between groups when comparing length of stay or mechanical ventilation days. CONCLUSIONS The combination of neuromuscular electrical stimulation, high protein supplementation and mobility and strength rehabilitation resulted in mitigation of lower extremity muscle loss and less delirium in mechanically ventilated ICU patients. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT02509520. Registered July 28, 2015.
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Affiliation(s)
- Avelino C Verceles
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Monica Serra
- Department of Medicine, Division of Geriatrics, Gerontology & Palliative Medicine, Sam and Ann Barshop Institute for Longevity and Aging Studies at University of Texas Health Science, San Antonio, TX, USA
| | - Derik Davis
- Division of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Gad Alon
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD
| | - Chris L Wells
- Department of Rehabilitation Services, University of Maryland Medical Center, Baltimore, MD, USA
| | - Elizabeth Parker
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD
| | - John Sorkin
- Department of Medicine, Division of Geriatrics and Palliative Medicine, University of Maryland School of Medicine, Baltimore MD, USA; Department of Veterans Affairs, Baltimore VA Maryland Health Care System, Geriatric Research, Education and Clinical Center, Baltimore, MD, USA
| | - Waqas Bhatti
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael L Terrin
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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15
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Akazawa N, Kishi M, Hino T, Tsuji R, Tamura K, Hioka A, Moriyama H. Longitudinal relationship between muscle mass and intramuscular adipose tissue of the quadriceps in older inpatients at different activities of daily living levels. Clin Nutr ESPEN 2023; 53:175-181. [PMID: 36657911 DOI: 10.1016/j.clnesp.2022.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/14/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND & AIMS Whether there is a longitudinal relationship between muscle mass and intramuscular adipose tissue of the quadriceps at different activities of daily living (ADL) levels remains unclear. This study aimed to examine the longitudinal relationship between muscle mass and intramuscular adipose tissue of the quadriceps in older inpatients at different ADL levels. METHODS This prospective cohort study was hospital-based and included 198 inpatients aged ≥65 years. Ultrasound images were acquired using B-mode ultrasound imaging. Muscle mass and intramuscular adipose tissue of the quadriceps were assessed based on muscle thickness and echo intensity, respectively. The changes in quadriceps thickness and echo intensity were calculated by subtracting these baseline values from these values at discharge. ADL were assessed at admission using the Barthel Index (BI). The participants were divided into the low BI (BI score <60) and high BI (BI score ≥60) groups in accordance with the BI score. Multiple regression analysis was performed to examine whether the change in quadriceps echo intensity was independently and significantly related to change in quadriceps thickness, even after adjusting for confounding factors in the total participants and high and low BI groups. RESULTS The number of the high and low BI groups were 54 and 144. Change in quadriceps echo intensity was independently and significantly related to changes in quadriceps thickness of the total participants (β = -0.53, p < 0.01) and low BI (β = - 0.51, p < 0.01) and high BI (β = -0.70, p < 0.01) groups. CONCLUSIONS The results of this study indicate that there is a longitudinal negative relationship between muscle mass and intramuscular adipose tissue of the quadriceps in older inpatients regardless of ADL level. Intramuscular adipose tissue may be an important contributing factor for muscle mass.
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Affiliation(s)
- Naoki Akazawa
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan.
| | - Masaki Kishi
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Japan
| | - Toshikazu Hino
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Japan
| | - Ryota Tsuji
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Japan
| | - Kimiyuki Tamura
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Japan
| | - Akemi Hioka
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan
| | - Hideki Moriyama
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan
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16
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Effect of electromyostimulation training on intramuscular fat accumulation determined by ultrasonography in older adults. Eur J Appl Physiol 2023; 123:271-282. [PMID: 36260185 PMCID: PMC9580431 DOI: 10.1007/s00421-022-05074-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 10/11/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Electromyostimulation (EMS) induces a short-term change in muscle metabolism, and EMS training induces long-term improvements of muscle atrophy and function. However, the effects of EMS training on intramuscular fat in older adults are still poorly known. The purpose of this study was to examine whether the intramuscular fat index and biochemical parameters change with EMS training of the quadriceps femoris muscles in older adults. METHODS Nineteen non-obese older men and women performed EMS training of the quadriceps femoris for 12 weeks (3 times/week; single session for 30 min). The intramuscular fat content index was estimated by echo intensity of the vastus lateralis and rectus femoris muscles on ultrasonography, and muscle thickness was also measured. Muscle strength was assessed as the maximal voluntary contraction during isometric knee extension. Echo intensity, muscle thickness, and muscle strength were measured before and after EMS training. A rested/fasting blood samples were collected before and after EMS training for measuring plasma glucose, insulin, free fatty acid, triglyceride, and interleukin-6 concentrations. To examine the acute effect of a single-EMS session on biochemical parameters, blood samples were taken before and after the EMS session. RESULTS EMS training did not significantly change echo intensity in muscles, muscle thickness, muscle strength, or biochemical parameters. Regarding the acute effect on blood lipid concentrations, a single-EMS session increased free fatty acid and glucose concentrations. CONCLUSION EMS sessions had an acute effect of increasing free fatty acid and glucose concentrations, but EMS training intervention did not improve intramuscular fat content.
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Yasuda T, Honda S, Matsunaga K, Hashimura T, Tsukamoto Y, Ota S, Fujita S, Onishi E. Association of preoperative muscle composition of the lower extremity with gait function after total knee arthroplasty. J Orthop Sci 2023; 28:188-194. [PMID: 34728112 DOI: 10.1016/j.jos.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/21/2021] [Accepted: 10/01/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Limitations of gait function persist in some patients with knee osteoarthritis after total knee arthroplasty. This study aimed to identify preoperative muscle composition variables of the operated limb associated with postoperative gait function. METHODS Longitudinal data from 45 patients who underwent unilateral primary total knee arthroplasty were retrospectively analyzed. Timed Up-and-Go test and gait speed were measured preoperatively and at 3 and 6 months postoperatively. Preoperative muscle composition in the glutei medius and minimus, the quadriceps, the hamstrings, and combination of the hamstrings and quadriceps were evaluated by computed tomography. The area ratio of the individual muscle composition to the total muscle was calculated. The factors associated with Timed Up-and-Go test and gait speed were identified using stepwise regression analysis. RESULTS Shorter Timed Up-and-Go test and faster gait speed at each time point correlated with higher lean muscle mass area of the total hamstrings, higher area ratio of lean muscle mass to the total hamstrings or to combination of the hamstrings and quadriceps, and lower area ratio of low density lean tissue or intramuscular adipose tissue to the total hamstrings. Shorter Timed Up-and-Go test at each time point also correlated with higher combined area of lean muscle mass of the hamstrings and quadriceps. Faster gait speed at each time point additionally correlated with lower area ratio of intramuscular fat to the total hamstrings and lower area ratio of lean tissue mass or intramuscular adipose tissue to combination of the hamstrings and quadriceps. Regression analysis using the significant muscle composition variables revealed that the area ratio of lean muscle mass to the total hamstrings was the only predictor of Timed Up-and-Go test and gait speed after operation. CONCLUSIONS Preoperative area ratio of ipsilateral lean muscle mass to the total hamstrings could predict gait function after total knee arthroplasty.
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Affiliation(s)
- Tadashi Yasuda
- Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
| | - Shintaro Honda
- Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Kazuhiro Matsunaga
- Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Takumi Hashimura
- Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Yoshihiro Tsukamoto
- Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Satoshi Ota
- Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Satoshi Fujita
- Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, 650-0047, Japan
| | - Eijiro Onishi
- Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, 650-0047, Japan
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Mohammed M, Li J. Stroke-Related Sarcopenia among Two Different Developing Countries with Diverse Ethnic Backgrounds (Cross-National Study in Egypt and China). Healthcare (Basel) 2022; 10:healthcare10112336. [PMID: 36421660 PMCID: PMC9689982 DOI: 10.3390/healthcare10112336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/24/2022] [Accepted: 11/05/2022] [Indexed: 11/23/2022] Open
Abstract
The prevalence of stroke-related sarcopenia differs according to the diagnostic criteria, the cut-off point for assessment, and ethnicity. Egypt and China are developing countries with different races where no research concerning stroke-related sarcopenia has been performed yet. We aimed to evaluate the prevalence of possible sarcopenia and confirmed sarcopenia among Egyptian and Chinese stroke survivors using the Asian Working Group of Sarcopenia (AWGS-2019) criteria and to assess the variables associated with the prevalence rate. A prospective cross-sectional study was carried out among 200 Egyptian and 195 Chinese stroke survivors from 2019 to 2021 using a structural health questionnaire. A hand-held dynamometer was used to measure grip strength. Anthropometric measures were used to estimate muscle mass. Data were analyzed using SPSS statistics version 20. p-values < 0.05 were considered statistically significant. The prevalence of possible sarcopenia ranged from 20.0% to 34.4% among Egyptian and Chinese groups, except for the Egyptian females where it was 52.0%. The prevalence of sarcopenia in both populations ranged from 13.6% to 18.6%. Pre-stroke independent variables that accelerated possible sarcopenia were age, history of dyslipidemia, diabetes mellitus, and ischemic heart disease, but stroke severity was a post-stroke risk factor. Age was the only pre-stroke variable for sarcopenia, while quitting smoking and having good nutritional status were variables for the reduction of possible sarcopenia. Quitting smoking, having a good nutritional status, and early rehabilitation reduced sarcopenia development. Controlling vascular risk factors, enhancing rehabilitation, and nutritional therapy are protective measures against sarcopenia. Longitudinal studies are required to identify further risk factors.
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Affiliation(s)
- Marwa Mohammed
- College of Rehabilitation Medicine, Nanjing Medical University, Nanjing 210029, China
- Faculty of Physical Therapy, Beni-Suef University, Beni-Suef 62521, Egypt
- First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China
| | - Jianan Li
- First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China
- Correspondence: ; Tel.: +86-137-7051-61766
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Li S, Gonzalez-Buonomo J, Ghuman J, Huang X, Malik A, Yozbatiran N, Magat E, Francisco GE, Wu H, Frontera WR. Aging after stroke: how to define post-stroke sarcopenia and what are its risk factors? Eur J Phys Rehabil Med 2022; 58:683-692. [PMID: 36062331 PMCID: PMC10022455 DOI: 10.23736/s1973-9087.22.07514-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/08/2022] [Accepted: 08/31/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Sarcopenia, generally described as "aging-related loss of skeletal muscle mass and function", can occur secondary to a systemic disease. AIM This project aimed to study the prevalence of sarcopenia in chronic ambulatory stroke survivors and its associated risk factors using the two most recent diagnostic criteria. DESIGN A cross-sectional observational study. SETTING A scientific laboratory. POPULATION Chronic stroke. METHODS Twenty-eight ambulatory chronic stroke survivors (12 females; mean age=57.8±11.8 years; time after stroke=76±45 months), hand-grip strength, gait speed, and appendicular skeletal muscle mass (ASM) were measured to define sarcopenia. Risk factors, including motor impairment and spasticity, were identified using regression analysis. RESULTS The prevalence of sarcopenia varied between 18% and 25% depending on the diagnostic criteria used. A significant difference was seen in the prevalence of low hand grip strength on the affected side (96%) when compared to the contralateral side (25%). The prevalence of slow gait speed was 86% while low ASM was present in 89% of the subjects. Low ASM was marginally negatively correlated with time since stroke and gait speed, but no correlation was observed with age, motor impairment, or spasticity. ASM loss, bone loss and fat deposition were significantly greater in the affected upper limb than in the affected lower limb. Regression analyses showed that time since stroke was a factor associated with bone and muscle loss in the affected upper limb, spasticity had a protective role for muscle loss in the affected lower limb, and walking had a protective role for bone loss in the lower limb. CONCLUSIONS The prevalence of sarcopenia in stroke survivors is high and is a multifactorial process that is not age-related. Different risk factors contribute to muscle loss in the upper and lower limbs after stroke. CLINICAL REHABILITATION IMPACT Clinicians need to be aware of high prevalence of sarcopenia in chronic stroke survivors. Sarcopenia is more evident in the upper than lower limbs. Clinicians also need to understand potential protective roles of some factors, such as spasticity and walking for the muscles in the lower limb.
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Affiliation(s)
- Sheng Li
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA -
- NeuroRecovery Research Center, TIRR Memorial Hermann Hospital, Houston, TX, USA -
| | | | | | - Xinran Huang
- Department of Biostatistics and Data Science, University of Texas Health Science Center, Houston, TX, USA
| | - Aila Malik
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
- NeuroRecovery Research Center, TIRR Memorial Hermann Hospital, Houston, TX, USA
| | - Nuray Yozbatiran
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
- NeuroRecovery Research Center, TIRR Memorial Hermann Hospital, Houston, TX, USA
| | - Elaine Magat
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
- NeuroRecovery Research Center, TIRR Memorial Hermann Hospital, Houston, TX, USA
| | - Gerard E Francisco
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
- NeuroRecovery Research Center, TIRR Memorial Hermann Hospital, Houston, TX, USA
| | - Hulin Wu
- Department of Biostatistics and Data Science, University of Texas Health Science Center, Houston, TX, USA
| | - Walter R Frontera
- Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
- Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
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Kameyama Y, Ashizawa R, Honda H, Take K, Yoshizawa K, Yoshimoto Y. Sarcopenia affects Functional Independence Measure motor scores in elderly patients with stroke. J Stroke Cerebrovasc Dis 2022; 31:106615. [PMID: 35780719 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106615] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/31/2022] [Accepted: 06/20/2022] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES There is no unified view of the relationship between sarcopenia and the activities of daily living (ADL) in stroke patients. This study aimed to determine whether sarcopenia affects the ADL in elderly patients with stroke. MATERIALS AND METHODS This case-control study included 472 stroke patients aged ≥ 65 years who were admitted to the convalescent rehabilitation ward. Sarcopenia was defined as a decrease in both the skeletal muscle mass index and handgrip strength, based on the Asian Working Group for Sarcopenia 2019 criteria cut-off, which was assessed on admission. ADL was assessed using the Functional Independence Measure-motor (FIM-m) score at discharge. The Charlson comorbidity index, Mini Nutritional Assessment-Short Form, Brunnstrom recovery stage of the upper limb, Brunnstrom recovery stage of the lower limb and total amount of rehabilitation during hospitalization were evaluated as confounding factors. To clarify whether sarcopenia affects the ADL in patients with stroke, we conducted a multiple regression analysis with the presence of sarcopenia as the independent variable and FIM-m at discharge as the objective variable. RESULTS The final analysis included 283 patients; among them, 163 (57.6%) patients had sarcopenia at the time of admission to the convalescent rehabilitation ward. In the multiple regression analysis, sarcopenia was independently associated with FIM-m at hospital discharge, even after adjusting for confounders (β = -0.100, p = 0.034). CONCLUSIONS Sarcopenia at admission in elderly patients with stroke affected the FIM-m at discharge, even after adjusting for multiple confounders.
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Affiliation(s)
- Yuto Kameyama
- Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Hamamatsu 433-8511, Japan; Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu 433-8558, Japan.
| | - Ryota Ashizawa
- Department of Rehabilitation, Seirei Mikatahara General Hospital, Hamamatsu 433-8558, Japan
| | - Hiroya Honda
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu 433-8558, Japan; Department of Rehabilitation, Hanadaira Care Center, Hamamatsu 431-2211, Japan
| | - Koki Take
- Visiting Nurse Station Takaoka, Seirei Care Center Takaoka, Hamamatsu 433-8117, Japan
| | - Kohei Yoshizawa
- Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Hamamatsu 433-8511, Japan; Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu 433-8558, Japan
| | - Yoshinobu Yoshimoto
- Division of Rehabilitation Science, Seirei Christopher University Graduate School, Hamamatsu 433-8558, Japan
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21
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Vanzella LM, Lawand R, Shuaib M, Oh P, Corbett D, Marzolini S. Validity of Bioelectric Impedance in Relation to Dual-Energy X-Ray Absorptiometry for Measuring Baseline and Change in Body Composition After an Exercise Program in Stroke. J Strength Cond Res 2022; 36:3273-3279. [DOI: 10.1519/jsc.0000000000004287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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22
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Onat ŞŞ, Polat CS, Gürçay E, Özcan DS, Orhan A. Muscle architecture and clinical parameters in stroke patients: An ultrasonographic study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:713-718. [PMID: 35338498 DOI: 10.1002/jcu.23202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/06/2022] [Accepted: 02/09/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE To compare the lower extremity muscle architecture on both the affected side and healthy sides using ultrasound (US) imaging and examine the relationship between these measurements and clinical parameters in stroke patients. METHODS A cross-sectional analysis of 125 stroke patients (64 M, 61 F) was performed in this study. Timed up and go (TUG) test was used to evaluate balance, Fugl-Meyer assessment of lower extremity (FMA-LE) was used to evaluate motor function, functional independence measurement (FIM) was used to evaluate functional status. Muscle thicknesses (MT) of rectus femoris (RF), vastus intermedius (VI), vastus medialis (VM), vastus lateralis (VL), soleus, medial gastrocnemius (GC) muscles, the PA and the FL of GC were obtained using ultrasound (US) imaging. RESULTS The muscle thickness, PA and FL of the affected side decreased significantly compared to the healthy side (p = .0001) in stroke patients. Another clear result was that soleus and GC muscle thicknesses and PA of GC muscle were found to be associated with balance, motor function, and functional status. CONCLUSION The properties of muscles evaluated with US may provide recommendations for clinical assessments and also potentially contribute to clinicians designing a rehabilitation intervention program for stroke patients.
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Affiliation(s)
- Şule Şahin Onat
- Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey
| | - Cemile Sevgi Polat
- Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey
| | - Eda Gürçay
- Gaziler Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey
| | - Didem Sezgin Özcan
- Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey
| | - Ali Orhan
- Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey
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23
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Huang M, Miller T, Fu SN, Ying MTC, Pang MYC. Structural and passive mechanical properties of the medial gastrocnemius muscle in ambulatory individuals with chronic stroke. Clin Biomech (Bristol, Avon) 2022; 96:105672. [PMID: 35617816 DOI: 10.1016/j.clinbiomech.2022.105672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 04/08/2022] [Accepted: 05/12/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study aimed to investigate the structural, morphological and passive mechanical properties of the medial gastrocnemius muscle among ambulating chronic stroke survivors using a computational model previously established in healthy individuals without stroke. METHODS Individuals with chronic stroke (n = 14, age = 63.4 ± 6.0 years) and healthy controls (n = 15, age = 59.6 ± 8.4 years) participated in the study. The mechanical properties of the medial gastrocnemius were measured during continuous passive ankle motion using ultrasound elastography and a corresponding muscle mechanical property-angle curve was estimated where slack angle and elasticity were determined. Muscle thickness, fascicle length, pennation angle, and echo intensity were also assessed using B-mode ultrasound. FINDINGS No significant differences in slack angle (paretic: -16.2° ± 6.13°, non-paretic: -16.93° ± 6.80°, p = 0.82), or slack elasticity (paretic: 4.36 ± 1.94 kPa, non-paretic: 4.54 ± 1.24 kPa, p = 0.64) were found between sides or groups. Lower muscle pennation angle (paretic: 13.6 ± 2.9°, non-paretic: 15.9 ± 2.0°, p = 0.019) and higher echo intensity (paretic: 80.5 ± 13.6, non-paretic: 63.4 ± 17.1, p = 0.003) were observed for paretic muscles. No significant between-sides differences were found for muscle thickness (paretic: 1.5 ± 0.3 cm, non-paretic: 1.6 ± 0.2 cm, p = 0.255) or fascicle length (paretic: 6.6 ± 1.9 cm, non-paretic: 7.1 ± 2.2 cm, p = 0.216). Significant between-groups difference was also observed for fascicle length [non-dominant side (control): 6.2 ± 0.8 cm, paretic side (stroke): 6.6 ± 1.9 cm, p = 0.017]. INTERPRETATION Although muscle mechanical properties increased exponentially over the slack ankle, measures between paretic and non-paretic sides were similar in ambulating participants with chronic stroke. Side-to-side differences in structural and morphological measures suggest the impact of stroke was relatively more pronounced for these muscle parameters than for passive mechanical properties.
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Affiliation(s)
- Meizhen Huang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
| | - Tiev Miller
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
| | - Siu Ngor Fu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
| | - Michael T C Ying
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong.
| | - Marco Y C Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
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24
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Irisawa H, Mizushima T. Assessment of changes in muscle mass, strength, and quality and activities of daily living in elderly stroke patients. Int J Rehabil Res 2022; 45:161-167. [PMID: 35170496 PMCID: PMC9071026 DOI: 10.1097/mrr.0000000000000523] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/31/2022] [Indexed: 11/25/2022]
Abstract
Whether poststroke rehabilitation improves muscle mass and quality along with the recovery of muscle strength is not clear. In this study, we examined the changes in muscle strength, muscle mass, and muscle quality in patients undergoing poststroke rehabilitation and assessed the relationship of these variables with improvement in activities of daily living (ADL). This prospective study was conducted at stroke rehabilitation unit in Japan. Muscle mass and quality were assessed using bioelectrical impedance analysis (BIA). ADLs were assessed using the functional independence measure (FIM). Grip strength of the nonaffected and affected sides was measured using hand dynamometer. All measurements were performed at admission to the stroke rehabilitation unit and at 4 weeks thereafter. We assessed changes in motor FIM items and examined the relationships among the measured variables. This study included 179 patients. Patients received stroke rehabilitation 7 days a week individually. Muscle strength and quality significantly increased after 4 weeks on both the sides. Muscle mass decreased after 4 weeks; however, there was no significant difference between the two time points. Changes in muscle strength and quality showed a significant correlation with improvement in ADLs [r = 0.66 (male), 0.45 (female) and 0.55 (male), 0.31 (female), respectively]; however, muscle mass showed no correlation with improvement in ADLs. Poststroke rehabilitation improves muscle strength and quality, as well as ADLs. Muscle mass is not an appropriate measure to assess the effects of stroke rehabilitation; it is desirable to instead use muscle strength and quality to assess stroke rehabilitation.
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Affiliation(s)
- Hiroshi Irisawa
- Department of Rehabilitation Medicine, Dokkyo Medical University, Mibu, Japan
| | - Takashi Mizushima
- Department of Rehabilitation Medicine, Dokkyo Medical University, Mibu, Japan
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25
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Wang T. Searching for the link between inflammaging and sarcopenia. Ageing Res Rev 2022; 77:101611. [PMID: 35307560 DOI: 10.1016/j.arr.2022.101611] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/14/2022] [Accepted: 03/15/2022] [Indexed: 12/17/2022]
Affiliation(s)
- Tiantian Wang
- Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China; Department of Rehabilitation Medicine, Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China.
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26
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Park MK, Lee SJ, Choi E, Lee S, Lee J. The Effect of Branched Chain Amino Acid Supplementation on Stroke-Related Sarcopenia. Front Neurol 2022; 13:744945. [PMID: 35359630 PMCID: PMC8963712 DOI: 10.3389/fneur.2022.744945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 02/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background Stroke-related sarcopenia is caused by various factors, such as brain damage, systemic catabolic state, skeletal muscle imbalance, and malnutrition. In the long-term care plan after stroke, appropriate rehabilitation strategies to achieve maximum functional improvement and prevent the development of sarcopenia are important. This study has investigated the effect of branched-chain amino acid (BCAA) supplementation on sarcopenia after stroke. We also evaluated the effect of BCAA on functional improvement during the intensive rehabilitation period. Methods Patients with subacute stroke with stroke-related disabilities were enrolled and given dietary supplement powder containing BCAAs for 1 month. These BCAAs were supplied through the nutrition team during feeding time. Patients whose age, sex, and stroke lesions were similar to those of the study group were enrolled in the control group through medical record review. Both groups received personalized intensive inpatient rehabilitation therapy in a single-unit rehabilitation center. All patients' target calories were calculated regularly by the nutritional support team in our institution. Sarcopenia status was evaluated using grip strength and the skeletal muscle index (SMI), which was assessed by dual-energy X-ray absorptiometry (DEXA). The functional status associated with stroke was evaluated every month, including activities of daily living, balance, gait, and swallowing. Results A total of 54 patients were enrolled, with 27 patients in each of the two groups. The study group showed significantly greater improvement in SMI after intervention than the control group. Both groups improved functionally over time, but the improvement in the study group was significantly greater than that in the control group. Univariate analysis revealed that patients with better functional status had a greater SMI with a combination of BCAA supplementation and intensive rehabilitation therapy. Conclusion Our results showed a positive effect of BCAA supplementation on sarcopenia after stroke. We also found that nutritional support helps functional improvement during neurological recovery. These results suggest that comprehensive rehabilitation intervention combined with BCAA supplementation could be a helpful option during the critical period of post-stroke neurological recovery.
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Affiliation(s)
- Min Kyu Park
- Department of Clinical Pharmacology and Therapeutics, College of Medicine, Chungbuk National University Hospital, Cheongju-si, South Korea
| | - Sook Joung Lee
- Department of Physical Medicine and Rehabilitation, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- *Correspondence: Sook Joung Lee
| | - Eunseok Choi
- Department of Physical Medicine and Rehabilitation, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sangjee Lee
- Department of Physical Medicine and Rehabilitation, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - JungSoo Lee
- Department of Physical Medicine and Rehabilitation, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Monjo H, Fukumoto Y, Asai T, Ohshima K, Kubo H, Tajitsu H, Koyama S. Changes in Muscle Thickness and Echo Intensity in Chronic Stroke Survivors: A 2-Year Longitudinal Study. J Clin Neurol 2022; 18:308-314. [PMID: 35196746 PMCID: PMC9163946 DOI: 10.3988/jcn.2022.18.3.308] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 09/08/2021] [Accepted: 09/08/2021] [Indexed: 12/04/2022] Open
Abstract
Background and Purpose The objective of this study was to identify 2-year longitudinal changes in the muscle thickness (MT) and echo intensity (EI) of the abdominal, thigh, and lower limb muscles in chronic stroke survivors. Methods This study included 15 chronic stroke survivors aged 74.1±9.9 years. The MT, EI, and subcutaneous fat thickness values of the following muscles on the paretic and nonparetic sides were assessed on transverse ultrasound images: rectus abdominis, external oblique, internal oblique, transversus abdominis, rectus femoris (RF), vastus intermedius, vastus lateralis (VL), vastus medialis, tibialis anterior, gastrocnemius, and soleus. The ultrasound measurements were performed both at baseline and 2 years later. Results After 2 years, the VL on the paretic side showed a significant decrease in MT (p=0.031) and increase in EI (p=0.002), whereas the RF on the nonparetic side showed a significant decrease in EI (p=0.046). Correlation coefficient analyses showed that changes in MT (r=0.668, p=0.012) and EI (r=0.597, p=0.018) of the VL on the paretic side were significantly associated with a change in the body mass index. Conclusions The findings of this longitudinal study suggest that the VL on the paretic side is subject to deteriorations in muscle quantity and quality, and conversely that the RF on the nonparetic side shows an improvement in muscle quality after 2 years in chronic stroke survivors.
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Affiliation(s)
- Hiroki Monjo
- Headquarters of Avanzar Co., Ltd, Akashi, Japan.
| | - Yoshihiro Fukumoto
- Department of Physical Medicine and Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Tsuyoshi Asai
- Department of Physical Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe, Japan
| | - Kensuke Ohshima
- Graduate School of Rehabilitation, Kobe Gakuin University, Kobe, Japan
| | - Hiroki Kubo
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Hirotsugu Tajitsu
- Department of Rehabilitation, National Hospital Organization Wakayama Hospital, Tanabe, Japan
| | - Shota Koyama
- Department of Rehabilitation, Saiseikai Hyogoken Hospital, Kobe, Japan
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Investigation of the Effect of Nutritional Supplementation with Whey Protein and Vitamin D on Muscle Mass and Muscle Quality in Subacute Post-Stroke Rehabilitation Patients: A Randomized, Single-Blinded, Placebo-Controlled Trial. Nutrients 2022; 14:nu14030685. [PMID: 35277045 PMCID: PMC8838798 DOI: 10.3390/nu14030685] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 02/05/2023] Open
Abstract
In post-stroke hemiparesis patients, the skeletal muscle mass decrease rapidly with the histological degradation. We investigated the effect of nutritional supplementation with whey protein and vitamin D on the muscle mass and muscle quality, in post-stroke convalescent rehabilitation patients in a randomized, single-blinded, placebo-controlled trial. Fifty patients were randomly assigned to two groups; HP group received supplemental jelly (100 kcal; whey protein 10 g; vitamin D 20 μg) twice a day throughout up to 16-week period, the control group received placebo jelly. Cross-sectional area (CSA) of thigh muscle, skeletal muscle index (SMI), muscle strength, activity of daily living (ADL), and some nutritional indicators in blood were measured. Although no significant difference was observed in CSA and SMI between the groups, fat infiltration into the thighs muscle was singnificantly lower in the HP group. There were no significant difference in muscle strength and ADL between the groups. Blood urea nitrogen and serum 25(OH)D at endpoint were significantly higher in the HP group but physiological normal ranges. Supplementation with whey protein and vitamin D in post-stroke patients led to suppression of fat infiltration into the muscle. Long-term follow-up studies are needed to verify whether this nutritional intervention provides substantial benefits for the prognosis of stroke survivors.
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Predictive Equations Overestimate Resting Metabolic Rate in Chronic Stroke Survivors. Arch Phys Med Rehabil 2022; 103:1352-1359. [DOI: 10.1016/j.apmr.2022.01.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/11/2022] [Accepted: 01/24/2022] [Indexed: 11/20/2022]
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Morel A, Ouamri Y, Canouï-Poitrine F, Mulé S, Champy CM, Ingels A, Audard V, Luciani A, Grimbert P, Matignon M, Pigneur F, Stehlé T. Myosteatosis as an independent risk factor for mortality after kidney allograft transplantation: a retrospective cohort study. J Cachexia Sarcopenia Muscle 2022; 13:386-396. [PMID: 34738343 PMCID: PMC8818595 DOI: 10.1002/jcsm.12853] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/27/2021] [Accepted: 09/30/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patients with end-stage renal disease may display both a loss of skeletal muscle mass and an increase in muscle fat deposits. We aimed to analyse the impact of low skeletal muscle mass index (SMI, surrogate marker of sarcopenia) and low muscle density (MD, surrogate marker of myosteatosis) on patient survival after kidney transplantation (KT). METHODS In a retrospective cohort of 200 kidney transplant recipients (KTr), we measured on an unenhanced cross-sectional computed tomography scan taken at the level of the third lumbar vertebra within the previous year or at the time of KT, both SMI (muscle cross-sectional area normalized for height2 , reported in cm2 /m2 ) and MD (mean attenuation of muscle cross-sectional area, expressed in Hounsfield units). We determined age-specific and sex-specific normality thresholds on 130 healthy subjects. The baseline factors associated with low MD were assessed by logistic regression analysis. Cox proportional hazard univariable and multivariable models were constructed to identify predictive factors of patient survival. RESULTS Among the 200 patients of the cohort, 123 were male (62%), and mean age was 54.8 ± 13.8 years. A total of 181 KTr required renal replacement therapy before KT (91%), and 36 KTr (18%) received repeat kidney transplant after previous failed KT. Mean MD was 30.6 ± 9 HU in men and 29.7 ± 8.3 HU in women, whereas SMI was 49.7 ± 8.6 cm2 /m2 in men and 42.3 ± 7.3 cm2 /m2 in women. MD was below the 2.5th percentile for the healthy population in 49 KTr (25%), defining the myosteatosis group, while SMI was below the 2.5th percentile for the reference population in 10 KTr (5%). Independent risk factors for myosteatosis were two or more KT [adjusted odds ratio (aOR) 5.2, 95% confidence interval (95% CI): 2.22-12.4, P = 0.0001], a history of stroke (aOR 3.7, 95% CI: 1.30-10.7, P = 0.015), and body mass index > 25 kg/m2 (aOR 2.94, 95% CI: 1.4-6.18, P = 0.004). Myosteatosis was independently associated with mortality [adjusted hazard ratio (aHR) 2.12, 95% CI: 1.06-4.24, P = 0.033], as were cardiovascular disease (HR 2.06, 95% CI: 1.02-4.15, P = 0.043) and age (aHR 1.06, 95% CI: 1.03-1.09, P = 0.0003). Low SMI was not associated with mortality. CONCLUSIONS Myosteatosis, which was more prevalent than low skeletal muscle mass, might be an important prognostic marker in patients undergoing KT.
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Affiliation(s)
- Antoine Morel
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo-Universitaire "Innovative Therapy for Immune Disorders", Créteil, France
| | - Yaniss Ouamri
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri-Mondor, Service d'Imagerie Médicale, Créteil, France
| | - Florence Canouï-Poitrine
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.,Clinical Epidemiology and Ageing Unit (CEpiA), Institut Mondor de Recherche Biomédicale, Paris-Est University, Créteil, France
| | - Sébastien Mulé
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri-Mondor, Service d'Imagerie Médicale, Créteil, France
| | - Cécile Maud Champy
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service d'Urologie, Groupe Hospitalier Henri-Mondor/Albert Chenevier, Créteil, France
| | - Alexandre Ingels
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.,Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service d'Urologie, Groupe Hospitalier Henri-Mondor/Albert Chenevier, Créteil, France
| | - Vincent Audard
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo-Universitaire "Innovative Therapy for Immune Disorders", Créteil, France
| | - Alain Luciani
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri-Mondor, Service d'Imagerie Médicale, Créteil, France
| | - Philippe Grimbert
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo-Universitaire "Innovative Therapy for Immune Disorders", Créteil, France
| | - Marie Matignon
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo-Universitaire "Innovative Therapy for Immune Disorders", Créteil, France
| | - Frédéric Pigneur
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri-Mondor, Service d'Imagerie Médicale, Créteil, France
| | - Thomas Stehlé
- Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France.,Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo-Universitaire "Innovative Therapy for Immune Disorders", Créteil, France
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Identifying sarcopenia among post-stroke older people. ENFERMERIA CLINICA 2021. [DOI: 10.1016/j.enfcli.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Ryan AS, Li G. Skeletal muscle myostatin gene expression and sarcopenia in overweight and obese middle‐aged and older adults. JCSM CLINICAL REPORTS 2021; 6:137-142. [PMID: 35311023 PMCID: PMC8932637 DOI: 10.1002/crt2.43] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Myostatin (MSTN) is a key negative regulator of muscle mass in humans and animals, having direct and indirect influences on molecular regulators of atrophy and hypertrophy, thus potentially impacting fitness and physical function. We have shown that myostatin is elevated in conditions of chronic disability (e.g. paretic limb of stroke). Our hypothesis is that myostatin would be elevated in older adults with sarcopenia. The purpose of this study was to examine the role of skeletal muscle myostatin in sarcopenia. Methods Sixty-four overweight to obese aged 45–81 years underwent a maximal aerobic capacity (VO2max) test, dual-energy X-ray absorptiometry (DXA) scan to determine appendicular lean tissue (ALM), and vastus lateralis muscle biopsy to determine myostatin mRNA expression by quantitative real time PCR (Q-RT-PCR). Rates of sarcopenia were determined using (ALM/BMI), and sarcopenia was defined as <0.789 in men and <0.512 in women. Subjects had low fitness (VO2max: 22.7 ± 0.7 mL/kg/min) and on average 40.9 ± 1% body fat. Results The prevalence of sarcopenia in this cohort was 16%. BMI, % body fat, and fat mass were higher in adults with sarcopenia than those without sarcopenia (all P < 0.001). Myostatin mRNA expression was lower in those without sarcopenia than those with sarcopenia (P < 0.05) and higher in men than women (P < 0.001). Myostatin expression was associated with BMI (r = 0.36, P < 0.01) and mid-thigh intramuscular fat (r = 0.29, P < 0.05). Conclusion Given that myostatin is important in muscle atrophy, fat accumulation, and sarcopenia, further work could address its implication in other aging cohorts of disability and chronic disease.
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Affiliation(s)
- Alice S. Ryan
- Department of Veterans Affairs, Department of Medicine, Division of Gerontology and Palliative Medicine, and the Baltimore VA Medical Center Geriatrics, Research, Education Center (GRECC) VA Maryland Health Care System Baltimore MD 21201 USA
| | - Guoyan Li
- Department of Veterans Affairs, Department of Medicine, Division of Gerontology and Palliative Medicine, and the Baltimore VA Medical Center Geriatrics, Research, Education Center (GRECC) VA Maryland Health Care System Baltimore MD 21201 USA
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33
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Choi Y, Im S, Park GY. Ultrasound Evaluation of the Rectus Femoris for Sarcopenia in Patients with Early Subacute Stroke. J Clin Med 2021; 10:3010. [PMID: 34300174 PMCID: PMC8303354 DOI: 10.3390/jcm10143010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/25/2021] [Accepted: 07/02/2021] [Indexed: 11/17/2022] Open
Abstract
We investigated the ultrasound characteristics of the rectus femoris for sarcopenia detected by dual-energy X-ray absorptiometry (DEXA) in the early subacute stroke phase. Physical features (age, sex, body mass index, and circumference of thigh) and performances (modified Barthel index in Korean, functional ambulation categories, and mini-mental state examination in Korean) were measured. The thickness of the fat layer, the thickness of the rectus femoris (TRF), echo intensity (EI), EI to TRF ratio, and strain ratio of elastography (SRE) were measured by ultrasound in 30 patients with first-ever stroke (male: n = 20). Appendicular lean body mass was measured by DEXA. Sarcopenia was defined according to the Foundation for the National Institutes of Health Sarcopenia Project. In total, 14 patients were in the sarcopenia group, and 16 were in the non-sarcopenia group. Clinical characteristics were similar between the two groups. In the sarcopenia group, TRF was significantly decreased in the paretic (p < 0.026) and non-paretic sides (p < 0.01), and the EI to TRF ratio on the paretic side was significantly increased (p < 0.049). Multivariate binary logistic regression showed that TRF on the non-paretic side was independently and significantly associated with sarcopenia (OR = 0.616, 95% CI: 0.381-0.996). The EI and SRE were not significant between the two groups. In the early subacute stroke phase, TRF on the non-paretic side is a key factor for quantitative evaluation of sarcopenia, and the EI to TRF ratio on the paretic side is also a meaningful qualitative evaluation of sarcopenia.
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Affiliation(s)
- Yongmin Choi
- Department of Rehabilitation Medicine, Dongsan Hospital, School of Medicine, Keimyung University, Daegu 42601, Korea;
| | - Sun Im
- Department of Rehabilitation Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 14647, Korea;
| | - Geun-Young Park
- Department of Rehabilitation Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 14647, Korea;
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34
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Miljkovic I, Vella CA, Allison M. Computed Tomography-Derived Myosteatosis and Metabolic Disorders. Diabetes Metab J 2021; 45:482-491. [PMID: 34352985 PMCID: PMC8369205 DOI: 10.4093/dmj.2020.0277] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 06/01/2021] [Indexed: 12/17/2022] Open
Abstract
The role of ectopic adipose tissue infiltration into skeletal muscle (i.e., myosteatosis) for metabolic disorders has received considerable and increasing attention in the last 10 years. The purpose of this review was to evaluate and summarize existing studies focusing on computed tomography (CT)-derived measures of myosteatosis and metabolic disorders. There is consistent evidence that CT-derived myosteatosis contributes to dysglycemia, insulin resistance, type 2 diabetes mellitus, and inflammation, and, to some extent, dyslipidemia, independent of general obesity, visceral fat, and other relevant risk factors, suggesting that it may serve as a tool for metabolic risk prediction. Identification of which muscles should be examined, and the standardized CT protocols to be employed, are necessary to enhance the applicability of findings from epidemiologic studies of myosteatosis. Additional and longer longitudinal studies are necessary to confirm a role of myosteatosis in the development of type 2 diabetes mellitus, and examine these associations in a variety of muscles across multiple race/ethnic populations. Given the emerging role of myosteatosis in metabolic health, well-designed intervention studies are needed to investigate relevant lifestyle and pharmaceutical approaches.
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Affiliation(s)
- Iva Miljkovic
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chantal A. Vella
- Department of Movement Sciences, College of Education, Health and Human Sciences, University of Idaho, Moscow, ID, USA
| | - Matthew Allison
- Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, La Jolla, CA, USA
- Corresponding author: Matthew Allison https://orcid.org/0000-0003-0777-8272 Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA E-mail:
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35
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Balch MHH, Harris H, Chugh D, Gnyawali S, Rink C, Nimjee SM, Arnold WD. Ischemic stroke-induced polyaxonal innervation at the neuromuscular junction is attenuated by robot-assisted mechanical therapy. Exp Neurol 2021; 343:113767. [PMID: 34044000 DOI: 10.1016/j.expneurol.2021.113767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/30/2021] [Accepted: 05/22/2021] [Indexed: 01/12/2023]
Abstract
Ischemic stroke is a leading cause of disability world-wide. Mounting evidence supports neuromuscular pathology following stroke, yet mechanisms of dysfunction and therapeutic action remain undefined. The objectives of our study were to investigate neuromuscular pathophysiology following ischemic stroke and to evaluate the therapeutic effect of Robot-Assisted Mechanical massage Therapy (RAMT) on neuromuscular junction (NMJ) morphology. Using an ischemic stroke model in male rats, we demonstrated longitudinal losses of muscle contractility and electrophysiological estimates of motor unit number in paretic hindlimb muscles within 21 days of stroke. Histological characterization demonstrated striking pre- and postsynaptic alterations at the NMJ. Stroke prompted enlargement of motor axon terminals, acetylcholine receptor (AChR) area, and motor endplate size. Paretic muscle AChRs were also more homogenously distributed across motor endplates, exhibiting fewer clusters and less fragmentation. Most interestingly, NMJs in paretic muscle exhibited increased frequency of polyaxonal innervation. This finding of increased polyaxonal innervation in stroke-affected skeletal muscle suggests that reduction of motor unit number following stroke may be a spurious artifact due to overlapping of motor units rather than losses. Furthermore, we tested the effects of RAMT - which we recently showed to improve motor function and protect against subacute myokine disturbance - and found significant attenuation of stroke-induced NMJ alterations. RAMT not only normalized the post-stroke presentation of polyaxonal innervation but also mitigated postsynaptic expansion. These findings confirm complex neuromuscular pathophysiology after stroke, provide mechanistic direction for ongoing research, and inform development of future therapeutic strategies. SIGNIFICANCE: Ischemic stroke is a leading contributor to chronic disability, and there is growing evidence that neuromuscular pathology may contribute to the impact of stroke on physical function. Following ischemic stroke in a rat model, there are progressive declines of motor unit number estimates and muscle contractility. These changes are paralleled by striking pre- and postsynaptic maladaptive changes at the neuromuscular junction, including polyaxonal innervation. When administered to paretic hindlimb muscle, Robot-Assisted Mechanical massage Therapy - previously shown to improve motor function and protect against subacute myokine disturbance - prevents stroke-induced neuromuscular junction alterations. These novel observations provide insight into the neuromuscular response to cerebral ischemia, identify peripheral mechanisms of functional disability, and present a therapeutic rehabilitation strategy with clinical relevance.
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Affiliation(s)
- Maria H H Balch
- Department of Biomedical Education and Anatomy, The Ohio State University College of Medicine, Columbus, OH, USA; Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Hallie Harris
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Deepti Chugh
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Surya Gnyawali
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Cameron Rink
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Shahid M Nimjee
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - W David Arnold
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Physical Medicine and Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Akazawa N, Kishi M, Hino T, Tsuji R, Tamura K, Hioka A, Moriyama H. Increased intramuscular adipose tissue of the quadriceps is related to decreased activities of daily living in patients who have had a stroke. Nutrition 2021; 90:111277. [PMID: 34010746 DOI: 10.1016/j.nut.2021.111277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 03/18/2021] [Accepted: 04/02/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study examined the relationships between intramuscular adipose tissue of the quadriceps on the paretic and non-paretic sides at admission and activities of daily living (ADL) at discharge in patients who had a stroke. METHODS This prospective cohort study included 44 stroke inpatients. ADL were assessed at discharge using the Barthel index (BI) score. Ultrasound images were acquired at admission using B-mode ultrasound imaging. Intramuscular adipose tissue and muscle mass of the quadriceps were assessed based on echo intensity and muscle thickness, respectively. Relationships between BI score at discharge and quadriceps echo intensity or thickness on the paretic and non-paretic sides were assessed using partial correlation coefficients. Age, sex, days from onset of stroke, Fugl-Meyer assessment lower extremity score, and subcutaneous fat thickness of the thigh were used as the control variables in the partial correlation analysis. RESULTS BI score at discharge was significantly related to quadriceps echo intensity on the paretic (partial correlation coefficient = -0.377, P = 0.018) and non-paretic (partial correlation coefficient = -0.364, P = 0.023) sides. By contrast, quadriceps thickness on the paretic (partial correlation coefficient = 0.284, P = 0.075) and non-paretic (partial correlation coefficient = 0.278, P = 0.083) sides were not significantly related to BI score at discharge. CONCLUSIONS The present study revealed the negative relationship between intramuscular adipose tissue of the quadriceps on the paretic and non-paretic sides at admission and ADL at discharge. Assessments and interventions of intramuscular adipose tissue in the quadriceps may be essential for predicting and improving ADL of patients who have had a stroke.
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Affiliation(s)
- Naoki Akazawa
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan.
| | - Masaki Kishi
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Toshikazu Hino
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Ryota Tsuji
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Kimiyuki Tamura
- Department of Rehabilitation, Kasei Tamura Hospital, Wakayama, Wakayama, Japan
| | - Akemi Hioka
- Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Tokushima, Japan
| | - Hideki Moriyama
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan
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37
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Akazawa N, Harada K, Okawa N, Kishi M, Tamura K, Moriyama H. Changes in Quadriceps Thickness and Echo Intensity in Chronic Stroke Survivors: A 3-Year Longitudinal Study. J Stroke Cerebrovasc Dis 2021; 30:105543. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/24/2020] [Accepted: 12/05/2020] [Indexed: 01/23/2023] Open
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Increased intramuscular adipose tissue of the quadriceps is more strongly related to declines in ADL than is loss of muscle mass in older inpatients. Clin Nutr 2021; 40:1381-1387. [DOI: 10.1016/j.clnu.2020.08.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/22/2020] [Accepted: 08/25/2020] [Indexed: 01/01/2023]
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Kokura Y, Kato M, Kimoto K, Okada Y, Habu D. Relationship between Energy Intake and Changes in Thigh Echo Intensity during the Acute Phase of Stroke in Older Patients with Hemiplegia. Med Princ Pract 2021; 30:493-500. [PMID: 34348295 PMCID: PMC8562031 DOI: 10.1159/000517950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 06/17/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the relationship between energy intake and changes in thigh echo intensity (TEI) during the acute phase of stroke in older patients with hemiplegia. SUBJECTS AND METHODS Older hemiplegic inpatients with stroke were enrolled in this post hoc analysis of a prospective observational study. Patients were divided into 2 groups according to energy intake during the 7 days after admission as follows: energy sufficient (ES) and energy insufficient (EIS) groups. The outcome was the rate of changes in TEI of the paralyzed and nonparalyzed sides between admission and after 4 weeks. A decrease in skeletal muscle quality is defined as an increase in intramuscular adipose tissues, which shows as an increase in echo intensity. RESULTS The study included 44 males and 39 females (median age 81 years). The rate of change of TEI in each group was as follows: +4.5% in the ES/paralyzed group, +6.7% in the EIS/paralyzed group, -0.9% in the ES/nonparalyzed group, and +4.4% in the EIS/nonparalyzed group. The univariate analyses showed no significant difference in the rate of change in TEI between ES and EIS groups in both paralyzed side (p = 0.190) and nonparalyzed side (p = 0.183). Multivariate analysis showed that higher energy intake was associated with a smaller increase in the rate of change in TEI on the nonparalyzed side (B = -4.115, 95% confidence interval, -7.127 to -1.103). CONCLUSIONS Higher energy intake during 7 days after admission was associated with a smaller increase in the rate of change in TEI on the nonparalyzed side upon admission and after 4 weeks.
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Affiliation(s)
- Yoji Kokura
- Department of Clinical Nutrition, Keiju Medical Center, Nanao, Japan
- Department of Medical Nutrition, Graduate School of Human Life Science, Osaka City University, Osaka, Japan
- *Yoji Kokura,
| | - Mayumi Kato
- Institute of Medical, Pharmaceutical and Health Sciences, National University Corporation Kanazawa University, Kanazawa, Japan
| | | | - Yoshie Okada
- Department of Neurosurgery, Keiju Medical Center, Nanao, Japan
| | - Daiki Habu
- Department of Medical Nutrition, Graduate School of Human Life Science, Osaka City University, Osaka, Japan
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Ryan AS, Hafer-Macko C, Ortmeyer HK. Insulin Resistance in Skeletal Muscle of Chronic Stroke. Brain Sci 2020; 11:brainsci11010020. [PMID: 33375333 PMCID: PMC7823711 DOI: 10.3390/brainsci11010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/11/2020] [Accepted: 12/18/2020] [Indexed: 11/16/2022] Open
Abstract
A stroke can lead to reduced mobility affecting skeletal muscle mass and fatty infiltration which could lead to systemic insulin resistance, but this has not been examined and the mechanisms are currently unknown. The objective was to compare the effects of in vivo insulin on skeletal muscle glycogen synthase (GS) activity in paretic (P) and nonparetic (NP) skeletal muscle in chronic stroke, and to compare to nonstroke controls. Participants were mild to moderately disabled adults with chronic stroke (n = 30, 60 ± 8 years) and sedentary controls (n = 35, 62 ± 8 years). Insulin sensitivity (M) and bilateral GS activity were determined after an overnight fast and during a hyperinsulinemic-euglycemic clamp. Stroke subjects had lower aerobic capacity than controls, but M was not significantly different. Insulin-stimulated activities of GS (independent, total, fractional), as well as absolute differences (insulin minus basal) and the percent change (insulin minus basal, relative to basal) in GS activities, were all significantly lower in P versus NP muscle. Basal GS fractional activity was 3-fold higher, and the increase in GS fractional activity during the clamp was 2-fold higher in control versus P and NP muscle. Visceral fat and intermuscular fat were associated with lower M. The effect of in vivo insulin to increase GS fractional activity was associated with M in control and P muscle. A reduction in insulin action on GS in paretic muscle likely contributes to skeletal muscle-specific insulin resistance in chronic stroke.
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Affiliation(s)
- Alice S. Ryan
- VA Research Service, Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
- Baltimore VA Medical Center Geriatric Research, Education and Clinical Center (GRECC), VA Maryland Health Care System, Baltimore, MD 21201, USA;
- Correspondence: ; Tel.: +1-410-605-7851
| | - Charlene Hafer-Macko
- Baltimore VA Medical Center Geriatric Research, Education and Clinical Center (GRECC), VA Maryland Health Care System, Baltimore, MD 21201, USA;
| | - Heidi K. Ortmeyer
- VA Research Service, Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
- Baltimore VA Medical Center Geriatric Research, Education and Clinical Center (GRECC), VA Maryland Health Care System, Baltimore, MD 21201, USA;
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Lanza MB, Addison O, Ryan AS, J Perez W, Gray V. Kinetic, muscle structure, and neuromuscular determinants of weight transfer phase prior to a lateral choice reaction step in older adults. J Electromyogr Kinesiol 2020; 55:102484. [PMID: 33176230 PMCID: PMC8209691 DOI: 10.1016/j.jelekin.2020.102484] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/06/2020] [Accepted: 10/14/2020] [Indexed: 12/25/2022] Open
Abstract
The present study aimed to investigate the association between rate of torque development (RTD), rate of activation (RoA), and muscle structure [muscle cross-sectional area (CSA), intramuscular fat (IMAT) and high density lean muscle (HDL)] with the weight transfer phase (WTP) during a choice reaction step test (CST) in older adults. Fifteen healthy older adults (7 females) participated in this study. Stance leg hip adductors RTD at 100, 150, and 200 ms, showed a significant inverse correlation with WTP (r ≥ 0.658, P ≤ 0.010). There was a significant inverse relationship between WTP and adductor magnus and tensor fascia latae RoA at all time points (RoA0-50-RoA0-200; r ≥ 0.707, P ≤ 0.033). In contrast, the WTP was not significantly associated with the hip abductor RTD, gluteus medius RoA, or muscle structure (CSA, IMAT, and HDL). Swing leg showed no significant relationship between WTP and RTD, RoA or muscle structure of the hip abductor or adductor muscles. In conclusion, the present study showed that hip adductor torque-time capacity, as well as neuromuscular activation of the adductor magnus and tensor fascia latae of the stance leg during a maximal isometric test, is associated with the ability to transfer body weight before a step to the side occurs.
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Affiliation(s)
- Marcel B Lanza
- Department of Physical Therapy and Rehabilitation, University of Maryland Baltimore, Baltimore, United States.
| | - Odessa Addison
- Department of Physical Therapy and Rehabilitation, University of Maryland Baltimore, Baltimore, United States; Baltimore Geriatric Research, Education, and Clinical Center, VAHMC, Baltimore, MD, United States
| | - Alice S Ryan
- Department of Medicine, University of Maryland School of Medicine, Division of Gerontology and Geriatric Medicine, United States; Baltimore Geriatric Research, Education, and Clinical Center, VAHMC, Baltimore, MD, United States
| | - William J Perez
- Baltimore Geriatric Research, Education, and Clinical Center, VAHMC, Baltimore, MD, United States
| | - Vicki Gray
- Department of Physical Therapy and Rehabilitation, University of Maryland Baltimore, Baltimore, United States
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42
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Tortora S, Tonin L, Chisari C, Micera S, Menegatti E, Artoni F. Hybrid Human-Machine Interface for Gait Decoding Through Bayesian Fusion of EEG and EMG Classifiers. Front Neurorobot 2020; 14:582728. [PMID: 33281593 PMCID: PMC7705173 DOI: 10.3389/fnbot.2020.582728] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/30/2020] [Indexed: 01/25/2023] Open
Abstract
Despite the advances in the field of brain computer interfaces (BCI), the use of the sole electroencephalography (EEG) signal to control walking rehabilitation devices is currently not viable in clinical settings, due to its unreliability. Hybrid interfaces (hHMIs) represent a very recent solution to enhance the performance of single-signal approaches. These are classification approaches that combine multiple human-machine interfaces, normally including at least one BCI with other biosignals, such as the electromyography (EMG). However, their use for the decoding of gait activity is still limited. In this work, we propose and evaluate a hybrid human-machine interface (hHMI) to decode walking phases of both legs from the Bayesian fusion of EEG and EMG signals. The proposed hHMI significantly outperforms its single-signal counterparts, by providing high and stable performance even when the reliability of the muscular activity is compromised temporarily (e.g., fatigue) or permanently (e.g., weakness). Indeed, the hybrid approach shows a smooth degradation of classification performance after temporary EMG alteration, with more than 75% of accuracy at 30% of EMG amplitude, with respect to the EMG classifier whose performance decreases below 60% of accuracy. Moreover, the fusion of EEG and EMG information helps keeping a stable recognition rate of each gait phase of more than 80% independently on the permanent level of EMG degradation. From our study and findings from the literature, we suggest that the use of hybrid interfaces may be the key to enhance the usability of technologies restoring or assisting the locomotion on a wider population of patients in clinical applications and outside the laboratory environment.
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Affiliation(s)
- Stefano Tortora
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Luca Tonin
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Carmelo Chisari
- Unit of Neurorehabilitation, Department of Medical Specialties, University Hospital of Pisa, Pisa, Italy
| | - Silvestro Micera
- Department of Excellence in Robotics and AI Scuola Superiore Sant'Anna, The Biorobotics Institute, Pisa, Italy.,Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, Lausanne, Switzerland
| | - Emanuele Menegatti
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Fiorenzo Artoni
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, Lausanne, Switzerland.,Functional Brain Mapping Laboratory, Department of Basic Neuroscience, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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43
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Longitudinal Relationship Between Intramuscular Fat in the Quadriceps and Gait Independence in Convalescent Stroke Patients. J Stroke Cerebrovasc Dis 2020; 29:105287. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105287] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/17/2020] [Accepted: 08/23/2020] [Indexed: 11/23/2022] Open
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44
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New understanding of the pathogenesis and treatment of stroke-related sarcopenia. Biomed Pharmacother 2020; 131:110721. [DOI: 10.1016/j.biopha.2020.110721] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/24/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022] Open
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45
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Mas MF, González J, Frontera WR. Stroke and sarcopenia. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020; 8:452-460. [PMID: 33777503 DOI: 10.1007/s40141-020-00284-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Purpose of review to evaluate recent scientific research studies related to the changes in skeletal muscle after stroke and the presence of sarcopenia in stroke survivors to establish its incidence and effects on function. Recent Findings Recently published findings on stroke-related sarcopenia are limited. This might be due to changes in the consensus definition of sarcopenia. Sarcopenia in stroke patients is estimated at 14 to 54%. The presence of sarcopenia at the time of a stroke can lead to worse recovery and functional outcomes. Summary Presence of sarcopenia prior to a stroke may be more common than suspected and can lead to worse functional recovery. Clinicians should be aware of this to better identify and treat stroke-related sarcopenia. Future research should focus on larger population studies to more accurately establish correlation between stroke and sarcopenia.
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Affiliation(s)
- Manuel F Mas
- Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Javier González
- Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Walter R Frontera
- Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico.,Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
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46
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Monjo H, Fukumoto Y, Asai T, Kubo H, Ohshima K, Tajitsu H, Koyama S. Differences in muscle thickness and echo intensity between stroke survivors and age- and sex-matched healthy older adults. Phys Ther Res 2020; 23:188-194. [PMID: 33489658 DOI: 10.1298/ptr.e10018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 05/28/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The stroke survivors exhibit change in muscle quantity and quality compared to healthy older adults. This study aimed to compare the muscle thickness (MT) and echo intensity (EI) values of individual muscles between stroke survivors and age- and sex-matched healthy older adults. METHODS In total, 27 stroke survivors and 34 healthy older adults participated in this study. The MT and EI values of the following muscles were assessed from transverse ultrasound images: rectus abdominis (RA), external oblique, internal oblique, transversus abdominis, rectus femoris, vastus intermedius (VI), vastus lateralis (VL), vastus medialis (VM), tibialis anterior (TA), gastrocnemius (Gas), and soleus (Sol). The MT and EI values of these muscles were compared between stroke survivors and healthy older adults. RESULTS The MT values of the VL, VM, and RA on the non-paretic sides were significantly higher and those of the TA, Gas, and Sol on the paretic sides were significantly lower in the stroke survivors than in the healthy older adults (P < 0.05). The EI values of the VI, VL, VM, TA on the paretic sides and those of the Gas on both the paretic and non-paretic sides were significantly higher in the stroke survivors than in the healthy older adults (P < 0.05). CONCLUSION Stroke survivors seem to develop muscle hypertrophy of the non-paretic thigh muscles owing to a compensatory strategy. In addition, the lower-leg muscles on the paretic side of stroke survivors tend to show both quantitative and qualitative muscle changes.
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Affiliation(s)
| | - Yoshihiro Fukumoto
- Department of Physical Medicine and Rehabilitation, Kansai Medical University
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47
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Correa-de-Araujo R, Addison O, Miljkovic I, Goodpaster BH, Bergman BC, Clark RV, Elena JW, Esser KA, Ferrucci L, Harris-Love MO, Kritchevsky SB, Lorbergs A, Shepherd JA, Shulman GI, Rosen CJ. Myosteatosis in the Context of Skeletal Muscle Function Deficit: An Interdisciplinary Workshop at the National Institute on Aging. Front Physiol 2020; 11:963. [PMID: 32903666 DOI: 10.3389/fphys.2020.00963/bibtex] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/15/2020] [Indexed: 05/26/2023] Open
Abstract
Skeletal muscle fat infiltration (known as myosteatosis) is an ectopic fat depot that increases with aging and is recognized to negatively correlate with muscle mass, strength, and mobility and disrupt metabolism (insulin resistance, diabetes). An interdisciplinary workshop convened by the National Institute on Aging Division of Geriatrics and Clinical Gerontology on September 2018, discussed myosteatosis in the context of skeletal muscle function deficit (SMFD). Its purpose was to gain a better understanding of the roles of myosteatosis in aging muscles and metabolic disease, particularly its potential determinants and clinical consequences, and ways of properly assessing it. Special attention was given to functional status and standardization of measures of body composition (including the value of D3-creatine dilution method) and imaging approaches [including ways to better use dual-energy X-ray absorptiometry (DXA) through the shape and appearance modeling] to assess lean mass, sarcopenia, and myosteatosis. The workshop convened innovative new areas of scientific relevance to light such as the effect of circadian rhythms and clock disruption in skeletal muscle structure, function, metabolism, and potential contribution to increased myosteatosis. A muscle-bone interaction perspective compared mechanisms associated with myosteatosis and bone marrow adiposity. Potential preventive and therapeutic approaches highlighted ongoing work on physical activity, myostatin treatment, and calorie restriction. Myosteatosis' impact on cancer survivors raised new possibilities to identify its role and to engage in cross-disciplinary collaboration. A wide range of research opportunities and challenges in planning for the most appropriate study design, interpretation, and translation of findings into clinical practice were discussed and are presented here.
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Affiliation(s)
- Rosaly Correa-de-Araujo
- Division of Geriatrics and Clinical Gerontology, National Institute on Aging, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, United States
| | - Odessa Addison
- Department of Veterans Affairs and Veterans Affairs Medical Center Baltimore, Geriatric Research, Education and Clinical Center (GRECC), Baltimore, MD, United States
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Iva Miljkovic
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Bret H Goodpaster
- AdventHealth Translational Research Institute, Orlando, FL, United States
| | - Bryan C Bergman
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Richard V Clark
- United States Anti-Doping Agency, Colorado Springs, CO, United States
| | - Joanne W Elena
- National Cancer Institute, National Institutes of Health, U.S Department of Health and Human Services, Bethesda, MD, United States
| | - Karyn A Esser
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, FL, United States
| | - Luigi Ferrucci
- Intramural Research Program, National Institute on Aging, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, United States
| | - Michael O Harris-Love
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Eastern Colorado VA Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States
| | - Steve B Kritchevsky
- Sticht Center for Healthy Aging and Alzheimer's Prevention Wake Forest School of Medicine, Winston-Salem, NC, United States
| | | | - John A Shepherd
- Department of Epidemiology, University of Hawaii Cancer Center, Honolulu, HI, United States
| | - Gerald I Shulman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Clifford J Rosen
- The Maine Medical Center Research Institute, Scarborough, ME, United States
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48
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Correa-de-Araujo R, Addison O, Miljkovic I, Goodpaster BH, Bergman BC, Clark RV, Elena JW, Esser KA, Ferrucci L, Harris-Love MO, Kritchevsky SB, Lorbergs A, Shepherd JA, Shulman GI, Rosen CJ. Myosteatosis in the Context of Skeletal Muscle Function Deficit: An Interdisciplinary Workshop at the National Institute on Aging. Front Physiol 2020; 11:963. [PMID: 32903666 PMCID: PMC7438777 DOI: 10.3389/fphys.2020.00963] [Citation(s) in RCA: 202] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/15/2020] [Indexed: 12/15/2022] Open
Abstract
Skeletal muscle fat infiltration (known as myosteatosis) is an ectopic fat depot that increases with aging and is recognized to negatively correlate with muscle mass, strength, and mobility and disrupt metabolism (insulin resistance, diabetes). An interdisciplinary workshop convened by the National Institute on Aging Division of Geriatrics and Clinical Gerontology on September 2018, discussed myosteatosis in the context of skeletal muscle function deficit (SMFD). Its purpose was to gain a better understanding of the roles of myosteatosis in aging muscles and metabolic disease, particularly its potential determinants and clinical consequences, and ways of properly assessing it. Special attention was given to functional status and standardization of measures of body composition (including the value of D3-creatine dilution method) and imaging approaches [including ways to better use dual-energy X-ray absorptiometry (DXA) through the shape and appearance modeling] to assess lean mass, sarcopenia, and myosteatosis. The workshop convened innovative new areas of scientific relevance to light such as the effect of circadian rhythms and clock disruption in skeletal muscle structure, function, metabolism, and potential contribution to increased myosteatosis. A muscle-bone interaction perspective compared mechanisms associated with myosteatosis and bone marrow adiposity. Potential preventive and therapeutic approaches highlighted ongoing work on physical activity, myostatin treatment, and calorie restriction. Myosteatosis’ impact on cancer survivors raised new possibilities to identify its role and to engage in cross-disciplinary collaboration. A wide range of research opportunities and challenges in planning for the most appropriate study design, interpretation, and translation of findings into clinical practice were discussed and are presented here.
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Affiliation(s)
- Rosaly Correa-de-Araujo
- Division of Geriatrics and Clinical Gerontology, National Institute on Aging, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, United States
| | - Odessa Addison
- Department of Veterans Affairs and Veterans Affairs Medical Center Baltimore, Geriatric Research, Education and Clinical Center (GRECC), Baltimore, MD, United States.,Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Iva Miljkovic
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Bret H Goodpaster
- AdventHealth Translational Research Institute, Orlando, FL, United States
| | - Bryan C Bergman
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Richard V Clark
- United States Anti-Doping Agency, Colorado Springs, CO, United States
| | - Joanne W Elena
- National Cancer Institute, National Institutes of Health, U.S Department of Health and Human Services, Bethesda, MD, United States
| | - Karyn A Esser
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, FL, United States
| | - Luigi Ferrucci
- Intramural Research Program, National Institute on Aging, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, United States
| | - Michael O Harris-Love
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Eastern Colorado VA Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States
| | - Steve B Kritchevsky
- Sticht Center for Healthy Aging and Alzheimer's Prevention Wake Forest School of Medicine, Winston-Salem, NC, United States
| | | | - John A Shepherd
- Department of Epidemiology, University of Hawaii Cancer Center, Honolulu, HI, United States
| | - Gerald I Shulman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Clifford J Rosen
- The Maine Medical Center Research Institute, Scarborough, ME, United States
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49
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Matsushita T, Nishioka S, Taguchi S, Yamanouchi A, Nakashima R, Wakabayashi H. Sarcopenic Obesity and Activities of Daily Living in Stroke Rehabilitation Patients: A Cross-Sectional Study. Healthcare (Basel) 2020; 8:healthcare8030255. [PMID: 32781673 PMCID: PMC7551564 DOI: 10.3390/healthcare8030255] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/04/2020] [Accepted: 08/04/2020] [Indexed: 12/12/2022] Open
Abstract
Reports investigating the relationship between sarcopenic obesity and activities of daily living in older patients with stroke were limited. This study aimed to examine the prevalence of sarcopenic obesity and its association with activities of daily living in older post-stroke patients in convalescent rehabilitation wards. This study was performed in older post-stroke patients admitted to convalescent rehabilitation wards between January 2017 and March 2019. Sarcopenia was diagnosed based on the skeletal muscle mass index and hand grip strength according to the criteria of the 2019 Asian Working Group for Sarcopenia. Obesity was diagnosed according to the body fat percentage; ≥27% in men, ≥38% in women. The primary outcome was the Functional Independence Measure (FIM) score upon admission, which was analyzed using multiple linear regression. In total, 376 participants (women 44%; mean age 77.5 years) were analyzed and classified as normal (22%), simple obesity (17%), sarcopenia without obesity (32%), and sarcopenic obesity (28%). The presence of sarcopenic obesity was independently associated with the FIM score (95% CI, -16.157 to -5.353), whereas simple obesity and sarcopenia without obesity were not. In conclusion, sarcopenic obesity was independently associated with lower activities of daily living capability in older patients with stroke.
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Affiliation(s)
- Tatsuya Matsushita
- Department of Clinical Services, Nagasaki Rehabilitation Hospital, Nagasaki 850-0854, Japan; (T.M.); (S.T.); (A.Y.); (R.N.)
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, Nagasaki 850-0854, Japan
- Correspondence: ; Tel.: +81-95-818-2002
| | - Shiori Taguchi
- Department of Clinical Services, Nagasaki Rehabilitation Hospital, Nagasaki 850-0854, Japan; (T.M.); (S.T.); (A.Y.); (R.N.)
| | - Anna Yamanouchi
- Department of Clinical Services, Nagasaki Rehabilitation Hospital, Nagasaki 850-0854, Japan; (T.M.); (S.T.); (A.Y.); (R.N.)
| | - Ryusei Nakashima
- Department of Clinical Services, Nagasaki Rehabilitation Hospital, Nagasaki 850-0854, Japan; (T.M.); (S.T.); (A.Y.); (R.N.)
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo 162-8666, Japan;
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50
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Bohannon RW. Isokinetic testing of muscle strength of older individuals post-stroke: An integrative review. ISOKINET EXERC SCI 2020. [DOI: 10.3233/ies-201146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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