Association of Fatigue With Sarcopenia and its Elements: A Secondary Analysis of SABE-Bogotá

Far-infrared stimulation of Neiguan acupoints improves heart rate variability and ameliorate fatigue in hemodialysis patients: A randomized trial

BACKGROUND

In 2018, 84 615 patients in Taiwan received hemodialysis, of which about 62% to 97% suffered from fatigue. Fatigue caused by hemodialysis may be mental or physical. However, the detailed mechanism remains unclear. This study aimed to evaluate whether far-infrared stimulation of the Neiguan acupoint (P6) could effectively reduce fatigue and improve heart rate variability (HRV) in hemodialysis patients.

METHODS

We conducted a two-arm, randomized trial in a hemodialysis center between March 2015 and March 2016. A total of 73 hemodialysis patients were included and were randomly assigned to an experimental group (n = 37) and a control group (n = 36). The experimental group received far-infrared radiation on Neiguan acupoint during hemodialysis for 12 weeks. The outcomes were fatigue level and HRV.

RESULTS

All patients showed moderate fatigue ( M = 26.00 ± 13.01, range = 0-78) at baseline. Far-infrared stimulation on Neiguan acupoint significantly reduced overall fatigue ( β = 24, p < 0.001) and improved HRV ( β = 74.36, p < 0.001). Compared to the control group, the experiment group had significantly reduced fatigue levels in all aspects such as reduced energy and motivation ( β = -2.97, p < 0.001), reduced physical strength ( β = -1.28, p < 0.01), reduced mental capability ( β = -2.38, p < 0.001), reduction in daily activities ( β = -1.48, p < 0.01), depressed mood and loss of control ( β = -1.21, p < 0.05) as well as increased autonomous nervous system activity ( β = 14.71, p < 0.01) in the third month of stimulation.

CONCLUSION

Far-infrared stimulation of the Neiguan acupoints effectively reduces fatigue and increases autonomic nervous system activity in hemodialysis patients.

Low muscle strength and physical function contribute to falls in hemodialysis patients, but not muscle mass

INTRODUCTION

Patients on hemodialysis (HD) have a higher incidence of fractures than the general population. Sarcopenia is frequently observed in patients on HD; however, the association of falls with sarcopenia and its diagnostic factors, including muscle mass, muscle strength, and physical function, are incompletely understood.

METHODS

This prospective cohort study was conducted at a single center. Sarcopenia was assessed according to the 2019 Asian Working Group for Sarcopenia diagnostic criteria. Muscle mass was measured the bioelectrical impedance method. Grip strength was evaluated to assess muscle strength, while the Short Physical Performance Battery (SPPB) was used to assess physical function. Falls and their detailed information were surveyed every other week.

RESULTS

This study analyzed 65 HD patients (median age, 74.5 [67.5-80.0] years; 33 women [49.2%]). Sarcopenia was diagnosed in 36 (55.4%) patients. During the 1-year observation period, 31 (47.7%) patients experienced accidental falls. The falls group had lower median grip strength than the non-falls group (14.7 [11.4-21.8] kg vs. 22.2 [17.9-27.6] kg; p < 0.001). The median SPPB score was also lower in the falls versus non-falls group (7.0 [5.0-11.0] vs. 11.0 [8.0-12.0]; p = 0.009). In adjusted multiple regression analysis, diagnostic factors, including grip strength (B = 0.96, p = 0.04, R2 = 0.19) and SPPB (B = 1.11, p = 0.006, R2 = 0.23), but not muscle mass, were independently associated with fall frequency.

CONCLUSIONS

The frequency of falls in HD patients was related to muscle strength and physical function, but not muscle mass.

Effectiveness and safety of subthreshold vibration over suprathreshold vibration in treatment of muscle fatigue in elderly people

Muscle fatigue is common in many populations, particularly elderlies. Aging increases the incidence of muscle fatigue and delays its recovery. There is a huge debate about the current treatments for muscle fatigue, particularly in elderlies. Recently, it has been discovered that mechanoreceptors have an important role as a sensory system in sensing muscle fatigue which could enhance the body's response to muscle fatigue. The function of mechanoreceptors could be enhanced by applying either suprathreshold or subthreshold vibration. Although suprathreshold vibration improves muscle fatigue, it can cause desensitization of cutaneous receptors, discomfort, and paresthesia, which are barriers to clinical use. Subthreshold vibration has been approved as a safe and effective method of training for mechanoreceptors; however, its use and effectiveness in muscle fatigue have never been tested or explained. Possible physiological effects of subthreshold vibration in the treatment of muscle fatigue include: (1) Enhancing the function of mechanoreceptors themselves; (2) Increasing the firing rate and function of alpha motor neurons; (3) Increasing blood flow to fatigued muscles; (4) Decreasing the rate of muscle cell death in elderlies (sarcopenia); and (5) Driving motor commands and allow better performance of muscles to decrease fatigue incidence. In conclusion, the use of subthreshold vibration could be a safe and effective treatment for muscle fatigue in elderlies. It could enhance recovery from muscle fatigue. Finally, Subthreshold Vibration is safe and effective in treating muscle fatigue in comparison to suprathreshold vibration.

Fatigue in older persons: the role of nutrition

Fatigue is defined as a symptom leading to the inability to continue functioning at the expected activity level. It is a highly prevalent symptom, challenging to frame into monodimensional pathophysiological mechanisms. As a result, fatigue is often underestimated in the clinical setting and is wrongly considered an unavoidable consequence of ageing. Several potential mechanisms responsible for fatigue have been proposed, including sleep patterns, autonomic nervous system abnormalities and biological complexity. Inflammation and mitochondrial dysfunction are among the most promising mechanisms through which malnutrition may cause fatigue. Not surprisingly, fatigue is highly prevalent in inflammatory conditions (e.g. COVID-19 infection). The nutritional status may also represent a critical factor in the development and presentation of fatigue, which may mimic the exhaustion of the individual's metabolic reserves. For example, the insufficient dietary intake of energy and proteins may determine the catabolism of body fat and muscles, disrupt the homeostatic balance and cause the onset of fatigue. It is necessary to conduct research on fatigue. By characterising its pathophysiological mechanisms, it will be possible to (1) support the design and development of targeted interventions, (2) improve the quality of life of many persons by acting on the symptom and (3) reduce the direct and indirect costs of a burdening condition typical of advancing age. In the present review, we provide an overview of the role that nutrition may play as a determinant of fatigue in older people, also in the context of the COVID-19 pandemic.

Prescription of resistance training for sarcopenic older adults: Does it require specific attention?

Sarcopenia is an age-related neuromuscular disease characterized by substantial muscle atrophy, dynapenia and/or loss of physical function. Sarcopenia progression increases the risk for numerous negative events, including falls, disability, hospitalization, nursing home placement, and death. As such, this condition is recognized as an important topic in gerontology and geriatrics. The best approach to counteract the development and progression of sarcopenia is actively debated. Resistance training (RT) has received special attention in this context, owing to the large number of studies showing its ability to produce significant improvements in sarcopenia-related parameters. Recommendations to guide RT prescription for older adults with different conditions, including people who have traits of sarcopenia, have been published. Some authors have argued that RT guidelines for older adults are similar to one another, which may indicate that the presence of sarcopenia does not require specific physical exercise programs. However, older people with sarcopenia might present with peculiar physical, biomechanical, physiological, and psychosocial characteristics that, in our view, are not taken into adequate consideration in existing exercise guidelines. Here, we present evidence to support the view that RT prescription for older adults with sarcopenia is complex, multifactorial, and still needs more evidence.

Prevalence of depression in patients with sarcopenia and correlation between the two diseases: systematic review and meta-analysis

BACKGROUND

Depression may be the most common cause of emotional distress later in life and can significantly reduce the quality of life in elderly individuals. Sarcopenia is a syndrome characterized by the continuous loss of skeletal muscle mass and decreased strength and function. In recent years, many studies have shown a correlation between sarcopenia and depression. The present study aimed to investigate the prevalence of depression among individuals with sarcopenia and to ascertain whether sarcopenia is independently associated with depression.

METHODS

We systematically searched the PubMed, Embase, and Google Scholar databases for papers on sarcopenia published up to 31 August 2021. We reviewed the literature on the number of individuals with sarcopenia, the number of individuals with both sarcopenia and depression, and the odds ratio (OR) of sarcopenia to depression. Statistical analyses were performed using Meta-DiSc 1.4 software and Stata version 12.0.

RESULTS

Nineteen articles met the inclusion criteria for review: nine reported both prevalence and ORs, four described prevalence only, and six detailed the ORs only. Regarding prevalence, there were 1476 cases of sarcopenia and 364 of depression in the selected studies; the mean age of the patients was 75.5 years, and the overall prevalence of depression was 0.28 [95% confidence interval (CI): 0.21-0.36]. Significant heterogeneity was noted (P < 0.001; I²  = 92.2%). In the case of ORs, there were 16 869 subjects with a mean age of 73 years; the overall adjusted OR between sarcopenia and depression was 1.57 (95% CI: 1.32-1.86). Significant heterogeneity was noted in the adjusted ORs (P < 0.001; I²  = 75.1%).

CONCLUSIONS

The prevalence of depression in patients with sarcopenia was high relatively, and there was a correlation between sarcopenia and depression.

Sarcopenia, severe anxiety and increased C-reactive protein are associated with severe fatigue in patients with inflammatory bowel diseases

Patients with inflammatory bowel disease (IBD) report fatigue more frequently than healthy population, but the precise mechanisms underlying its presence are unknown. This study aimed to evaluate the prevalence of fatigue in IBD and its relation with potential causative factors. A survey on fatigue, depression, anxiety, sleep disorders, and the presence of sarcopenia and malnutrition, was sent by email to 244 IBD outpatients of the Gastroenterology Unit of Academic Hospital of Padua. Demographics and clinical data, including the levels of fecal calprotectin (FC) and C-reactive protein (CRP), and current pharmacological treatments were obtained from patients' medical records. Ninety-nine (40.5%) subjects answered the survey. Ninety-two (92.9%) patients reported fatigue, with sixty-six having mild to moderate fatigue and twenty-six severe fatigue. Multivariate analysis showed that abnormal values of CRP (OR 5.1), severe anxiety (OR 3.7) and sarcopenia (OR 4.4) were the factors independently associated with severe fatigue. Fatigue has a high prevalence in subject affected by IBD. Subjects with altered CRP, sarcopenia and severe anxiety appear more at risk of severe fatigue.

Associations of sleep and depression with obesity and sarcopenia in middle-aged and older adults

OBJECTIVES

To analyze the association of depression and the quality and duration of sleep with general and abdominal obesity, sarcopenia, and sarcopenic obesity (SO) in Spanish middle-aged and older adults.

STUDY DESIGN AND OUTCOME MEASURES

A total of 304 people (mean age 72.04 ± 7.88 years, 83.88 % women) participated in this study. Body mass index, waist circumference, skeletal muscle mass index (bioelectrical impedance analysis), and hand-grip strength were used to evaluate sarcopenia, obesity, and SO. The Pittsburgh Sleep Quality Index was used to evaluate sleep quality. Sleep duration (hours) was categorized as either short (<6), normal (6-8), or long (>8). Depression was measured using the Hospital Anxiety and Depression Scale. Fatigue (Fatigue Severity Scale), nutritional status (Mini Nutritional Assessment Survey) and physical activity (PA) level (International Physical Activity Questionnaire-Short Form) were also assessed. Independent associations were evaluated by multivariate logistic regressions.

RESULTS

Only depression was associated with sarcopenia (OR = 1.10, 95 % CI = 1.02-1.19). Poorer sleep quality (OR = 1.06, 95 % CI = 1.06-1.11) and short sleep duration (OR = 2.63, 95 % CI = 1.45-4.78) were related to general obesity, as well as fatigue and low PA level. Poor sleep latency (OR = 1.43, 95 % CI = 1.09-1.87) was linked to abdominal obesity, along with fatigue, low PA level, older age, and female sex. Finally, short sleep duration (OR = 5.25, 95 % CI = 1.97-14.00), together with fatigue, low PA level, and male sex were associated with OS.

CONCLUSION

Among Spanish middle-aged and older adults, after adjusting for potential confounding variables, depression was uniquely associated with sarcopenia, while short sleep duration was related to general and sarcopenic obesity, and poor sleep quality was linked to general and abdominal obesity.

Metabolic Syndrome and Its Associated Factors in Older Adults: A Secondary Analysis of SABE Colombia in 2015

Background: Understanding the metabolic syndrome (MetS) prevalence at the national level is important to develop effective programs and strategies to prevent and control MetS. This study aimed to analyze the prevalence of MetS according to gender and aging stage, and its association with potential factors in older individuals ≥60 years of age in Colombia. Methods: The data for this study came from a secondary cross-sectional, nationally representative SABE study Survey on Health, Well-Being, and Aging in Colombia, 2015. A total of 1637 participants (60.7% women, 70.5 ± 7.9 years) from 86 Colombian municipalities participated. A structured questionnaire was used to collect data on socio-demography, lifestyle, and self-report medical conditions. Measurements included anthropometric (weight, waist circumference, body mass index), sarcopenia "proxy" status (calf circumference) handgrip strength levels, high-density lipoprotein cholesterol, triglycerides, fasting glucose, and blood pressure. Univariate and multiple regression models were established as part of the main analysis. Results: Using the harmonized Joint Scientific Statement criteria, MetS was present in 54.9% of the study population, with a higher prevalence among females than males (59.8% vs. 47.3%). Individuals who were cigarette smokers (odds ratio [OR] = 1.5; 95% confidence interval [CI] = 1.0-2.4; P = 0.034), female gender (OR = 1.3; 95% CI = 1.0-1.8; P = 0.020), and sarcopenia "proxy" (OR = 1.6; 95% CI = 1.0-2.5; P = 0.026) were more likely to have a higher prevalence estimate of MetS, after controlling for relevant covariates. Conclusions: Overall prevalence of MetS among older adults in Colombia is high. Smoking, female gender, and sarcopenia "proxy" status are associated with MetS. These results suggested that MetS is still a serious public burden in Colombia, and screening for promotion of healthy lifestyle and nutrition counseling should be offered routinely in old age.

Prevalencia de dinapenia (disminución de la fuerza), sarcopenia y posibles biomarcadores en rehabilitación cardíaca

Introducción: la relación entre dinapenia y sarcopenia da como resultado un aumento adicional en el riesgo de morbimortalidad en la población general, con un incremento progresivo de acuerdo con la edad. A partir de los 30 años debido a la disminución de la masa muscular y de la fuerza, se afecta la capacidad de ejercicio, la calidad de vida y el estado de ánimo. Objetivo: determinar la prevalencia de dinapenia y sarcopenia en los pacientes en rehabilitación cardíaca de un hospital colombiano, con mediciones de la fuerza y de los marcadores bioquímicos. Métodos: estudio de corte transversal en mayores de 40 años en rehabilitación cardíaca con controles al menos una vez por semana. La medición de la fuerza se realizó con dinamómetro de mano, la masa muscular con impedanciómetro bipolar y velocidad de la marcha con la prueba de caminata de 6 metros. Se tomaron mediciones de hormona de crecimiento (GH), testosterona libre, somatomedina IGF-1 y cortisol. Resultados: la disminución de la fuerza muscular fue prevalente en hombres (n=15, 19.4%; mujeres n=5, 10%). La prevalencia de dinapenia fue 15,7% y sarcopenia 0%. Los resultados obtenidos fueron GH 0.27 (0.08-1.18), testosterona 5.9 (0.3-8.5), IGF-1 126 (95.5-169) cortisol 13.9 (11.2-18.4). Las patologías más frecuentes de los pacientes del programa fueron infarto del miocardio, angioplastia e implantación de stent. Conclusiones: la prevalencia de dinapenia fue 15.7%. No se encontró diferencia alguna de los marcadores bioquímicos en los pacientes con y sin dinapenia.

Can Proprioceptive Training Enhance Fatigability and Decrease Progression Rate of Sarcopenia in Seniors? A Novel Approach

Sarcopenia is a common condition in older adults, which causes the frequent occurrence of muscle fatigue. Muscle fatigue commonly develops among seniors. Muscle fatigue is a type of physical fatigue that occurs due to either motor or sensory dysfunctions. Current interventions developed to decrease the occurrence of muscle fatigue, which include either increasing rest periods or subdividing large tasks into small ones. The effectiveness of these interventions is highly contradicted. Recently, researchers discovered that mechanoreceptors are the main receptors of muscle fatigue, however, no clinical study investigated the effect of performing proprioceptive training to enhance the mechanoreceptors and decrease the occurrence of muscle fatigue. Performing proprioceptive training could improve muscle fatigue by improving its sensory part. The function of mechanoreceptors might consequently enhance fatigue and decrease the progression rate of sarcopenia. Thus, this review was conducted to suggest a novel approach of treatment to enhance fatigue and decrease Sarcopenia in seniors. This might be accomplished through increasing the firing rate of α- motor neurons, increasing the amount of Ca²⁺ ions in the neuromuscular junction, slowing the progression rate of Sarcopenia, and correcting movement deviations, which commonly occur with muscle fatigue in seniors. In conclusion, proprioceptive training could play an effective role in decreasing the progression rate of sarcopenia and enhancing the fatigability among seniors.

Nutritional Status as a Mediator of Fatigue and Its Underlying Mechanisms in Older People

Fatigue is an often-neglected symptom but frequently complained of by older people, leading to the inability to continue functioning at a normal level of activity. Fatigue is frequently associated with disease conditions and impacts health status and quality of life. Yet, fatigue cannot generally be completely explained as a consequence of a single disease or pathogenetic mechanism. Indeed, fatigue mirrors the exhaustion of the physiological reserves of an older individual. Despite its clinical relevance, fatigue is typically underestimated by healthcare professionals, mainly because reduced stamina is considered to be an unavoidable corollary of aging. The incomplete knowledge of pathophysiological mechanisms of fatigue and the lack of a gold standard tool for its assessment contribute to the poor appreciation of fatigue in clinical practice. Inadequate nutrition is invoked as one of the mechanisms underlying fatigue. Modifications in food intake and body composition changes seem to influence the perception of fatigue, probably through the mechanisms of inflammation and/or mitochondrial dysfunction. Here, we present an overview on the mechanisms that may mediate fatigue levels in old age, with a special focus on nutrition.