Effects of a Multicomponent Exercise Program in Physical Function and Muscle Mass in Sarcopenic/Pre-Sarcopenic Adults

Development of a community intervention combining social media-based health education plus exercise programme (SHEEP) to improve muscle function among young-old adults with possible sarcopenia: Co-design approach

OBJECTIVES

There is no precedent for the use of social media in preventing sarcopenia. The aim of this study is to develop a social media-based intervention programme for the young-old population in the community in China to improve their awareness and behaviours regarding sarcopenia prevention.

STUDY DESIGN

Using guidelines for developing complex interventions, this study was divided into two main phases: a co-development phase and a preliminary test phase. Both were carried out in Changsha, China. The development phase employed co-design methodology with relevant stakeholders, including two rounds of consultation with patient and public involvement (12 members) and two rounds of focus groups (30 participants); this was followed by the three-week preliminary test phase (22 participants).

MAIN OUTCOME MEASURES

This study evaluated the consultation with patient and public involvement, and mainly collected qualitative data from the two rounds of focus group interviews and a final semi-structured interview following the preliminary test, so as to explore the participants' experiences, comments, and suggestions for revising the social media-based intervention. Handgrip strength was also evaluated.

RESULTS

The health education included seven videos of 4-6 min each related to sarcopenia, including information on the concept, influencing factors, adverse effects, manifestations, screening methods, and preventions. The exercise video consisted of four types of training (warm-up, aerobic, resistance, and flexibility training) and lasted 30 min, with a suggested engagement of at least 3 days/week. The specific contents and "dosage" of the final intervention were unanimously favourable to the diverse stakeholders involved (older adults with possible sarcopenia, experts, researchers). After the preliminary test, an improvement in handgrip strength was observed, from M15.92±SD5.22 kg to M19.13±SD5.44 kg (T = -5.44, P < 0.001). Subgroup analysis revealed that this improvement was evident in both men and women.

CONCLUSIONS

The social media-based intervention was universally endorsed by the participants and showed indications of a positive influence on sarcopenia. A feasibility study is now needed.

Effect of multicomponent exercise intervention in community dwelling frail elderly: A systematic review and meta-analysis

OBJECTIVE

To assess the impact of multicomponent exercises on physical functions of frail elderly in communities, evaluating their effect on muscle strength, balance, and endurance, and their influence on quality of life.

METHOD

PubMed, Embase, Cochrane, and Web of Science were searched to collect relevant randomized controlled trials. The search cutoff date was January 24, 2024. Included studies met pre-specified inclusion and exclusion criteria. Data analysis was performed using Revman 5.4 and Stata 15.0 software.

RESULT

This analysis included 19 studies. After 12 weeks, the multicomponent exercises significantly enhanced participants' performance in various physical function assessments. Specifically, in the Timed Up and Go Test, the exercise group showed a significant reduction in time [SMD = -0.86 (95 % CI: -1.40 to -0.33)]. In the Short Physical Performance Battery, interventions shorter than 6 weeks significantly increased scores [SMD = 1.01 (95 % CI: 0.64 to 1.37)], and those longer than 6 weeks showed improvements [SMD = 0.53 (95 % CI: 0.26 to 0.80)]. Muscle strength also improved, with handgrip strength and knee extensor strength enhancements [SMD = 0.93 (95 % CI: 0.27 to 1.59); SMD = 0.72 (95 % CI: 0.24 to 1.20)]. However, there was no statistically significant difference in walking speed between the groups [SMD = 0.04 (95 % CI: -0.33 to 0.40)].

CONCLUSION

Although multicomponent exercises significantly improve muscle strength, balance, and endurance in frail elderly individuals, there is no conclusive evidence of their effect on enhancing quality of life or long-term health outcomes. Further research is needed to explore the specific impacts of different types and intensities of exercises on this population.

Highlighting the effect of reduced training volume on maintaining hormonal adaptations obtained from periodized resistance training in sarcopenic older women

BACKGROUND

This study investigated the impact of the High Intensity Interval Resistance Training (HIIRT) protocol on hormonal changes in older women.

RESEARCH DESIGN AND METHODS

Forty sarcopenic women were divided into an experimental group (EX = 30) and a control group (C = 10). The EX-group was further divided into Maintenance Training 1 (MT1 = 10), Maintenance Training 2 (MT2 = 10), and Detraining (DT = 10). The participants underwent 8 weeks of resistance training, consisting of hypertrophy and strength cycles. Following this, the EX-group had a 4-week period with no exercise or a reduced training volume. Measurements were taken at three time points.

RESULTS

After 8 weeks, the EX-group showed significant improvements in Insulin Like Growth Factor-1 (IGF-1), Myostatin (MSTN), Follistatin (Fstn), Growth Hormone (GH) and Cortisol (Cort) compared to the control group. During the volume reduction period, there were no significant differences between MT1 and MT2 groups, but both groups saw increases in IGF-1, Fstn, GH, and decreases in MSTN and Cort compared to the DT group.

CONCLUSIONS

These findings suggest that performing at least one training session per week with the HIIRT protocol is crucial for maintaining hormonal adaptations in sarcopenic older women.

The Perspective of Rehabilitation Nurses on Physical Exercise in the Rehabilitation of Older People in the Community: A Qualitative Study

In the face of an increasingly aging population, nurses have to design and implement programs aimed at the elderly in order to keep them healthy and maintain their quality of life. Structured physical exercise and overall physical activity play a major role in maintaining an active lifestyle, improving health, preventing disease, and helping to maintain older people's quality of life. To investigate the importance of implementing physical exercise programs for the older person in the community, taking into account the perspective of the rehabilitation nurse specialist, this is a qualitative, exploratory, and descriptive study with nine rehabilitation nurses from various regions of Portugal who have experience of implementing physical exercise programs with the elderly. This study used semi-structured interviews, one of the most common data collection procedures in social and health research. Content analysis was used to analyze the data. The study received a positive opinion from the Ethics Committee. The participants' perspectives focused on the following subjects: "Physical exercise program for the elderly in the community", "Importance of physical exercise in the rehabilitation of the elderly in the community", "People's adherence to the programs", "Gains in health resulting from the implementation of these strategies" and "Gains from group activities". A set of indicators emerged from the analysis. Nurses recognize the importance of using structured physical exercise programs adjusted to the rehabilitation of the older person, with gains in promoting active and healthy aging.

A Cardiopulmonary Exercise Testing for Prescribing High-Intensity Interval Training Sessions with Elastic Resistance

This study aims to analyze the agreement of cardiopulmonary variables between a cardiopulmonary exercise test with elastic resistance (CPxEL) and high-intensity interval exercise with elastic resistance (EL-HIIE).

METHODS

Twenty-two physically independent participants were recruited. Visit one consisted of conducting a health survey and anthropometric assessment. On visit two, the participants performed CPxEL. After seven days, on visit three, the participants performed EL-HIIE. The CPxEL was carried out on a rubber mat demarcated by lines representing eight stages. The test consisted of alternating back and forth steps against elastic resistance. The increments were performed at a rate of one stage per minute, following a cadence controlled by a metronome calibrated by beats per minute (bpm). The EL-HIIE was performed at the stage corresponding to an intensity of ~85% VO2max, as determined by CPxEL. The EL-HIIE consisted of 10 × 1 min (work):1 min (passive rest), with a cadence of 200 bpm. Cardiopulmonary parameters, heart rate (HR), and oxygen consumption (VO2) were measured during exercise. Bland-Altman was applied to analyze the agreement between the HR and VO2 found in EL-HIIE and the values prescribed by CPxEL (~85-90% VO2max).

RESULTS

The HRpeak and VO2peak in the EL-HIIE showed good agreement with the VO2CPxEL and HRCPxEL values, showing an average difference of (-1.7 mL·kg-1·min-1) and (0.3 bpm).

CONCLUSIONS

The results of the present study demonstrate the agreement of cardiopulmonary variables between the CPxEL and the EL-HIIE. Therefore, for a more specific prescription of EL-HIIE intensity, CPxEL can be used.

Effect of a moderate-intensity comprehensive exercise program on body composition, muscle strength, and physical performance in elderly females with sarcopenia

Objective

This study aimed at examining an eight-week moderate-intensity comprehensive exercise training program on the parameters of sarcopenia in elderly females.

Methods

A total of 49 community-dwelling elderly females with sarcopenia (65.5 ± 2.5) were assigned randomly to an experiment group (EG, n = 25) and a control group (CG, n = 24). In the EG, an eight-week comprehensive exercise training program was implemented, in 1 h, 3 times per week, a total of 24 sessions. The CG only received health public education per two weeks, a total of 4 times. Subsequently, the differences between the two groups were tested through two-way repeated ANOVA.

Results

ASM, SMM, and SMI in the EG were significantly improved by 0.26 kg, 0.18 kg, and 0.10 kg/m2, respectively. Group-by-time interactions were significantly different on the ASM [F (1,47) = 6.25, η2 = 0.12] and SMI [F (1,47) = 6.77, η2 = 0.13]. Muscle strength was improved 0.8 kg in the EG. Significant group-by-time interaction differences were reported in the handgrip strength [F (1,47) = 6.8, η2 = 0.13] after the eight-week intervention. Compared with the baseline, gait speed was improved a 0.05 m/s and 5-time chair stand was decreased a 0.27 s in the EG. Group-by-time interactions were significantly different in 5-time chair stand [F (1, 47) = 6.35, η2 = 0.12].

Conclusions

The moderate-intensity comprehensive exercise was confirmed as a safe and convenient exercise program. Although a load of training intensity is not sufficient to improve the gait speed, this exercise protocol is promising in delaying overall results in community-dwelling sarcopenia elderly females and contributes to the improvement of muscle mass, handgrip strength, and 5TCS.

Optimal exercise to improve physical ability and performance in older adults with sarcopenia: a systematic review and network meta-analysis

OBJECTIVE

The study aimed to pool and analyze the effects of different forms of exercise on muscle strength (handgrip strength [HGS]), and physical performance (timed up and go test [TUGT], gait speed [GS] and chair stand test [CS]) in older adults with sarcopenia.

METHODS

The effect sizes of all studies retrieved and included by the four databases were analyzed using the network meta-analysis and expressed as standardized mean differences (SMD) and the corresponding 95% confidence intervals (CI).

RESULTS

Twenty studies were included in this study with 1347 older adults with sarcopenia. Compared with control and other intervention groups, resistance training (RT) improved HGS [SMD=3.8, 95% CI (1.3, 6.0), p<0.05] and TUGT [SMD = -1.99, 95% CI (-2.82, -1.16), p<0.05] significantly. comprehensive training (CT) [SMD = -2.04, 95% CI (-3.05, -1.06), Pp<0.05] and Comprehensive training under self-management (CT_SM) [SMD = -2.01, 95% CI (-3.24, -0.78), p<0.05] improved TUGT significantly.

CONCLUSION

In older adults with sarcopenia, RT could improve HGS and TUGT, CT and CT_SM could improve TUGT. There were no significant changes in CS and GS with any of the exercise training modes.

Exploring biomarkers of osteosarcopenia in older adults attending a frailty clinic

Osteosarcopenia is a new definitional approach that can increase the risk of falls and fractures in elderly compared with that of osteoporosis and sarcopenia alone. However, biomarkers for osteosarcopenia have not been well identified. Thus, we aimed to explore the biomarkers of osteosarcopenia, including bone, muscle, and geriatric markers. Outpatients attending a frailty clinic were enrolled in the study. Osteosarcopenia was defined as the coexistence of osteoporosis and sarcopenia. Osteoporosis was defined according to the criteria of the Japan Osteoporosis Society. Sarcopenia was defined according to the Asian Working Group for Sarcopenia consensus (2019). We selected 35 blood/serum pathological parameters, including bone, inflammation, nutritional, and aging markers for the study. Logistic regression analysis for osteosarcopenia was performed to explore the biomarkers of osteosarcopenia. Of the total 600 patients with a mean age of 76.6 years, 595 were enrolled in the registry during the study period. Logistic regression analysis for osteosarcopenia showed that elevated thyroid-stimulating hormone (TSH) (odds ratio [OR]:1.375; 95 % confidence interval [CI]: 1.092-1.731), bone-specific alkaline phosphatase (BAP) (OR: 1.059; 95 % CI: 1.002-1.120), and estimated glomerular filtration rate (eGFR) (OR: 1.029; 95 % CI: 1.007-1.053) increased the likelihood of osteosarcopenia. On the other hand, elevated 25-hydroxyvitamin D (25OHD) (OR: 0.905; 95 % CI: 0.841-0.974), blood urea nitrogen (BUN) (OR: 0.895; 95 % CI: 0.829-0.966) and K (OR: 0.241; 95 % CI: 0.081-0.717) decreased the likelihood of osteosarcopenia. It is worthwhile to examine these biomarkers for older adult outpatients attending a frailty clinic for screening osteosarcopenia. Further studies are needed to investigate the effects of other markers of bone metabolism.

Prevalence of possible sarcopenia in community-dwelling older Chinese adults: a cross-sectional study

OBJECTIVES

To determine the prevalence of possible sarcopenia and its association with other conditions in older adults in Bengbu, China.

DESIGN, SETTING AND PARTICIPANTS

A cross-sectional study of 1082 community-dwelling Chinese people aged at least 60 years from March to June 2022.

METHODS

Handgrip strength and information regarding associated conditions were collected. Possible sarcopenia was estimated based on handgrip strength with cut-off values (<28 kg in men; <18 kg in women) recommended by the Asia Working Group for Sarcopenia in 2019. Mann-Whitney U tests, χ² tests and binary logistic regression analyses were used to explore relationships between possible sarcopenia and associated conditions.

RESULTS

Possible sarcopenia was more prevalent in men (52.79%, n=246, age 79.43±7.33 years among men with possible sarcopenia) than in women (44.48%, n=274, age 78.90±7.71 years among women with possible sarcopenia). In men, possible sarcopenia positively correlated with high age (OR 2.658, 95% CI 1.758 to 4.019), physical inactivity (OR 2.779, 95% CI 1.646 to 4.691) and diabetes (OR 4.269, 95% CI 2.397 to 7.602), and negatively with hypertension (OR 0.586, 95% CI 0.384 to 0.893). The risk of possible sarcopenia in men decreased by 12.6% for every 1 kg/m² increase of body mass index (OR 0.874, 95% CI 0.817 to 0.935). In women, possible sarcopenia positively correlated with high age (OR 3.821, 95% CI 2.677 to 5.455), physical inactivity (OR 2.185, 95% CI 1.488 to 3.210) and arthritis (OR 2.076, 95% CI 1.411 to 3.056).

CONCLUSION

Possible sarcopenia is prevalent in older adults and the factors affecting possible sarcopenia are different in men and women. Health education about these target factors can be considered as a potential measure to prevent possible sarcopenia.

Effects of Multicomponent Exercise Training on the Health of Older Women with Osteoporosis: A Systematic Review and Meta-Analysis

This study aimed to analyze the effects of multicomponent exercise training in older women with osteoporosis. We conducted a systematic review following the PRISMA guidelines and registered on PROSPERO (number CRD42022331137). We searched MEDLINE (via PubMed), Web of Science, Scopus, and CINHAL databases for randomized experimental trials that analyzed the effects of physical exercise on health-related variables in older women with osteoporosis. The risk of bias in the studies was verified using the Cochrane Collaboration tool and the Jadad scale was used to assess the methodological quality of the studies. Fourteen randomized controlled trials were included, with a total of 544 participants in the experimental group and 495 in the control group. The mean age of all participants was 68.4 years. The studies combined two to four different exercise types, including strength, aerobic, balance, flexibility, and/or functional fitness training. The practice of multicomponent training with an average of 27.2 weeks, 2.6 sessions per week, and 45 min per session showed improvements in strength, flexibility, quality of life, bone mineral density, balance, and functional fitness and reduced the risk of falls in older women with osteoporosis. Multicomponent training was shown to be effective in improving health-related variables in older women with osteoporosis.

Diet-induced inflammation is associated with sarcopenia and muscle strength in older adults who visit a frailty clinic

BACKGROUND

Diet-induced inflammation may be associated with sarcopenia; however, few reports have examined this relationship.

AIM

To examine the association between the dietary inflammatory index (DII) and sarcopenia in older adults who visited a frailty clinic in Japan.

METHODS

This cross-sectional study used outpatient data from the Frailty Registry Study. The DII is an index of diet-induced inflammation, and a dietary assessment was performed using a brief self-administered diet history questionnaire to calculate the DII score. We classified DII scores by quartiles (Q1-Q4), and sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019 consensus. Logistic regression analyses for sarcopenia were performed. Age, sex, comorbidities, and physical activity were entered as confounding factors (Model 1) and Models 2, 3, and 4 with BMI, protein intake, and energy intake added to Model 1.

RESULTS

We included 304 patients in the analysis (mean age, 77.6 ± 6.3 years; female, 67.4%). The prevalence of sarcopenia was 14.5%. Logistic regression analyses showed that DII scores were significantly associated with sarcopenia in Model 1 and 2 (Model 1, reference: Q1, Q4: OR 3.10, P = 0.020; Model 2, Q4: OR 3.40, P = 0,022) but not in Model 3 and 4.

DISCUSSION

Diet-induced inflammation is associated with a higher likelihood of sarcopenia; however, this association disappeared after confounding for protein and energy intake.

CONCLUSIONS

The results demonstrated that dietary protein and energy parameters were the main drivers for muscle health in medical patients.

Evaluating the feasibility of a remote-based training program supported by information and communications technology in the older adults living at home

Background

Exercise has been one of the key strategies for preventing frailty. While training programs for preventing frailty have been mainly developed in person, which have now become difficult to perform due to the coronavirus disease pandemic. It would be worthwhile to explore a feasibility of methods for a remote-based training with information and communications technology (ICT) in the pre-frail/robust older adults living at home.

Methods

We assessed the feasibility of a remote-based training with ICT device in terms of 1) a measurement accuracy and 2) whether it could be used for remote-based training of different intensities. To evaluate a measurement accuracy of the ICT device, we evaluated an inter-rater reliability between a true score and scores obtaining from the ICT device in 20 participants aged 65 years and older. Intraclass correlation was calculated. To evaluate a feasibility of remote-based training interventions of different intensities, we did a parallel, randomized, active controlled trial. Participants aged 65 years or older were randomly allocated to the two 3-month intervention programs with different intensity of exercise with the ICT (i.e., an Exercise-Intensive program and a Light-load exercise program). The primary outcome was 3-month scores of the 30-s chair-stand test (CS-30), which was compared between two groups using mixed models for repeated measures to account for within-person correlations.

Results

The ICT device showed a high intraclass correlation of over 0.99 for all outcomes including CS-30. Between Aug and Oct 2020, 70 participants (36 and 34 in the Exercise-Intensive and Light-load exercise programs, respectively) were randomized. After 3 months of intervention, CS-30 scores and other physical function improved in both groups. Difference in the 3-month CS-30 scores between two programs was found to be 0.08 (95% confidence interval: − 2.64, 2.79; p = 0.955), which was not statistically significant. No harmful incidents, such as falls, occurred in either group.

Conclusion

We showed a remote-based training with ICT device in the older adults living at home was feasible. Further studies are warranted to determine what kind of remote exercise intervention programs is more effective for maintaining a physical performance and, beyond that, preventing frailty.

Trial registration number

UMIN000041616 (05/09/2020) https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&recptno=R000047504&type=summary&language=E

Osteosarcopenia, the co-existence of osteoporosis and sarcopenia, is associated with social frailty in older adults

BACKGROUND

Osteosarcopenia is a newly described, aging-associated condition. Social frailty is an important condition whose prevalence may have risen by physical distancing during the coronavirus disease 2019 pandemic. However, the relationship between these two remains unclear.

AIMS

To examine the association between osteosarcopenia and social frailty.

METHODS

This cross-sectional study was conducted using data from outpatients visiting general geriatric hospital frailty clinics. Bone mineral density (BMD) and muscle mass were measured using dual X-ray absorptiometry. Osteoporosis was defined as a BMD of < 70% of the young adult mean, according to the Japan Osteoporosis Society. Sarcopenia was diagnosed as per the Asian Working Group for Sarcopenia 2019 recommendation. Osteosarcopenia was defined as the co-existence of osteoporosis and sarcopenia. We defined social frailty using a questionnaire comprising four items: general resources, social resources, social behavior, and basic social needs. Ordinal logistic regression analysis was performed with social frailty status and osteosarcopenia as the dependent and independent variables, respectively.

RESULTS

We included 495 patients (mean age = 76.5 ± 7.2 years) in the analysis; of these, 58.2% were robust and 17.2%, 13.5%, and 11.1% had osteoporosis alone, sarcopenia alone, and osteosarcopenia, respectively. Social frailty prevalence increased stepwise from 8.0% in robust patients to 11.8%, 17.9%, and 29.1% among those with osteoporosis alone, sarcopenia alone, and osteosarcopenia, respectively (P < 0.001). Logistic regression analysis revealed that only osteosarcopenia was significantly associated with social frailty (pooled odds ratio: 2.117; 95% confidence interval: 1.104-4.213).

DISCUSSION

Comprehensive assessment of osteosarcopenia and social frailty is needed for disability prevention in older adults.

A review of the components of exercise prescription for sarcopenic older adults

PURPOSE

To synthesize the details of the exercises/exercise program prescribed for the improvement of muscle mass/muscle strength/physical performance among sarcopenic older adults.

METHODS

A systematic literature search was conducted in five electronic databases and the details of exercises such as single component or multicomponent exercise program, frequency/week, intensity, duration of the exercise program, type of exercises, progression, adverse events reported, outcome measures used, and whether technology or other educational aids were used to deliver the program were extracted.

RESULTS

A total of 10,045 records were identified and 27 records were included. Resistance exercises were included in all the studies, with the frequency ranging from 1 to 5/week, intensity ranging from 20 to 80% of 1 repetition maximum (RM), or 6-14 points on ratings of perceived exertion (RPE), and duration per session ranging from 20 to 75 min. The intensity of aerobic exercises ranged from 50 to 70% of heart rate max or a level of 7-17 in RPE with a duration ranging from 6 to 30 min per session for 2-5 days/week. For balance exercises, the intensity was mentioned as the level of effort 3 on a scale of 10, and the time duration per session ranged from 5 to 30 min for a frequency of 2/3 per week.

CONCLUSION

This review synthesized the components of exercise prescription for sarcopenic older adults which would help practitioners and researchers in selecting the frequency, intensity, duration, type, mode, and progression while prescribing exercises.

Effect Of Exercise on Muscle Mass, Fat Mass, Bone Mass, Muscular Strength and Physical Performance in Community Dwelling Older Adults: Systematic Review and Meta-Analysis

The demographic transition makes it necessary to establish new recommendations about the components that are most affected by aging, such as: muscle mass, fat mass, bone mass, muscle strength, and physical performance. Exercise has been identified as a factor that improves those conditions. The aim of this review is to synthetize and analyze the results of exercise interventions on muscle mass, fat mass, bone mass, strength and physical performance in community dwelling older adults (OA). A systematic search was carried out in eleven databases, using validated terms as “aged”, “exercise” and others. For the meta-analysis, we differentiated by type of exercise and outcome. Twenty-nine randomized clinical trials were obtained for the review and 24 clinical trials for meta-analysis. This study identified an increase of 1.0 kg (95% Confidence Interval [CI] 0.3 -1.7) in total muscle mass (TMM) and 0.4 kg (95%CI 0.0,0.7) in appendicular muscle mass (AMM); a decrease of -3.7 kg (95% CI -5.8, -1.5) in total fat mass and -3.7% (95%CI -5.8, -1.5) in fat percentage after the resistance exercise intervention by 2-3 times per week. A -3.0% (95%CI -4.6, -1.3) decrease was observed in fat percentage after the aerobic exercise intervention. The quality of the evidence was ranked from high to very low; the risk of bias most common was performance bias and other bias. This study suggests that resistance exercise is the intervention that shows a positive effect on muscle fat mass, and bone mass. More research is needed for other exercise interventions.

Effects of different exercise training modes on muscle strength and physical performance in older people with sarcopenia: a systematic review and meta-analysis

OBJECTIVE

We conducted a systematic review and meta-analysis to clarify the effects of different exercise modes (resistance training [RT], whole body vibration training [WBVT], and mixed training [MT, resistance training combined with other exercises such as balance, endurance and aerobic training]) on muscle strength (knee extension strength [KES]) and physical performance (Timed Up and Go [TUG], gait speed [GS] and the Chair Stand [CS]) in older people with sarcopenia.

METHOD

All studies published from January 2010 to March 2021 on the effects of exercise training in older people with sarcopenia were retrieved from 6 electronic databases: Pubmed, Cochrane Library, Embase, Web of Science, the China National Knowledge Infrastructure (CNKI), and Wanfang Database. Two researchers independently extracted and evaluated studies that met inclusion and exclusion criteria. Pooled analyses for pre- and post- outcome measurements were performed using Review Manager 5.4 with standardized mean differences (SMDs) and fixed-effect models.

RESULT

Twenty-six studies (25 randomized controlled trails [RCTs] and one non-randomized controlled trail) were included in this study with 1191 older people with sarcopenia (mean age 60.6 ± 2.3 to 89.5 ± 4.4). Compared with a control group, RT and MT significantly improved KES (RT, SMD = 1.36, 95% confidence intervals [95% CI]: 0.71 to 2.02, p < 0.0001, I2 = 72%; MT, SMD = 0.62, 95% CI: 0.29 to 0.95, p = 0.0002, I2 = 56%) and GS (RT, SMD = 2.01, 95% CI: 1.04 to 2.97, p < 0.0001, I2 = 84%; MT, SMD = 0.69, 95% CI: 0.29 to 1.09, p = 0.008, I2 = 81%). WBVT showed no changes in KES (SMD = 0.65, 95% CI: - 0.02 to 1.31, p = 0.06, I2 = 80%) or GS (SMD = 0.12, 95% CI: - 0.15 to 0.39, p = 0.38, I2 = 0%). TUG times were significantly improved with all exercise training modes (SMD = -0.66, 95% CI: - 0.94 to - 0.38, p < 0.00001, I2 = 60%). There were no changes in CS times with any of the exercise training modes (SMD = 0.11, 95% CI: - 0.36 to 0.57, p = 0.65, I2 = 87%).

CONCLUSIONS

In older people with sarcopenia, KES and GS can be improved by RT and MT, but not by WBVT. All three training modes improved TUG times, but not improved CS times.

Associations of alpha-actinin-3 genotype with thigh muscle volume and physical performance in older adults with sarcopenia or pre-sarcopenia

BACKGROUND

This cross-sectional study aimed to investigate the relationship of the ACTN3 genotype with thigh muscle volume and physical performance in older adults with sarcopenia or pre-sarcopenia.

METHODS

Data from 64 older Japanese adults (mean age 74.4 ± 6.9 years, women 71.9%) with sarcopenia or pre-sarcopenia were analyzed. Sarcopenia and pre-sarcopenia were defined using the Asian Working Group for Sarcopenia. We collected oral mucosa samples to determine the ACTN3 genotype. Thigh muscle volumes were measured using magnetic resonance imaging. Physical performance was assessed using the usual and maximum gait speed, timed up and go test, and five-repetition sit-to-stand test. Muscle strength was assessed using grip strength.

RESULT

The ACTN3 genotype proportions were 20.3% for RR, 51.6% for RX, and 28.1% for XX. Participants with the RR genotype showed greater thigh muscle volume/ht² compared to those with the RX and XX ACTN3 genotypes (p < 0.05). The multiple linear regression analysis revealed that RX (p < 0.01) and XX (p < 0.01) ACTN3 genotypes, compared to RR, were associated with lower thigh muscle volume/ht² and with age, sex (reference; men), weight and maximum walking speed. There was no significant difference between physical performance and muscle strength between the ACTN3 genotypes.

CONCLUSION

The ACTN3 genotype of the X allele was associated with decreased thigh muscle volume compared to the ACTN3 genotype of RR in older adults with sarcopenia or pre-sarcopenia.

Association between osteosarcopenia and cognitive frailty in older outpatients visiting a frailty clinic

PURPOSE

Osteosarcopenia and cognitive frailty are both risk factors for falls and fractures. The purpose of this study was to determine the association between osteosarcopenia and cognitive frailty.

MATERIALS AND METHODS

This was a cross-sectional secondary data analysis of the Frailty Registry Study with outpatients aged ≥65 years who visited a frailty clinic at a geriatric hospital. Osteoporosis was defined as a bone mineral density < 70% of the young adult mean. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019 criteria. Cognitive frailty was defined as the coexistence of physical frailty and mild cognitive impairment. Physical frailty was evaluated according to Japanese Cardiovascular Health Study criteria, whereas mild cognitive impairment was defined as a Mini-Mental State Examination score ≥ 24 points and a score ≤ 25 points on the Japanese version of the Montreal Cognitive Assessment. We performed multivariable logistic regression analysis to investigate the association between osteosarcopenia and cognitive frailty.

RESULTS

The data of 432 patients were analysed. The prevalence of osteosarcopenia and cognitive frailty was 10.2% and 20.8%, respectively. Logistic regression analysis revealed that osteosarcopenia was independently associated with cognitive frailty with a higher odds ratio than osteoporosis or sarcopenia alone. Lost points in visuospatial abilities/executive functions and orientation were significantly associated with osteosarcopenia.

CONCLUSIONS

Combination of osteoporosis and sarcopenia is more likely to be associated with physical and cognitive decline than osteoporosis and sarcopenia alone. The mechanism by which osteosarcopenia is associated with decreased visuospatial abilities/executive functions and orientation needs to be addressed.

Effect of Home-Based Exercise Program on Physical Function and Balance in Older Adults With Sarcopenia: A Multicenter Randomized Controlled Study

In the prospective, randomized, controlled multicenter study, 100 patients who were clinically diagnosed with sarcopenia were assigned to either a home-based exercise group or a control group. The home-based training program included exercises with gradually increasing intensity comprising posture, stretching and upper- and lower-extremity muscle-strengthening exercises, balance and coordination exercises, and gait training. Before and 3 months after the exercise program, all the patients were evaluated. The 6-min walking test and Berg Balance Scale scores increased significantly after 3 months in the home-based exercise group compared with the controls. There was also a significant decrease in timed up and go test scores and a significant improvement in quality of life in the exercise group compared with the control group. Our findings indicated that a home-based exercise program can have a positive effect on physical function, balance, and quality of life in patients with sarcopenia.

Diagnostic accuracy of sarcopenia by "possible sarcopenia" premiered by the Asian Working Group for Sarcopenia 2019 definition

PURPOSE

The Asian Working Group for Sarcopenia 2019 (AWGS 2019) proposed a simple assessment of sarcopenia called "possible sarcopenia" for the purpose of early detection and intervention of sarcopenia. The purpose of this study was to report the accuracy of possible sarcopenia against definitive sarcopenia and the characteristics of false-negative cases.

MATERIALS AND METHODS

This was a cross-sectional study using a research registry with outpatients aged ≥65 years who visited a frailty clinic at a geriatric hospital. The diagnosis of possible sarcopenia and sarcopenia was performed according to the AWGS 2019 criteria, using calf circumference (CC) for case-finding. The accuracy of the diagnosis of sarcopenia in participants with possible sarcopenia was evaluated by calculating sensitivity, specificity, and F-value.

RESULTS

Of the 349 patients (mean age, 78.0±6.0 years; 63% women) analyzed, 86 (24.6%) revealed possible sarcopenia. Possible sarcopenia predicted sarcopenia with a sensitivity of 0.893 and 0.921, specificity of 0.990 and 0.870, and F-values of 0.926 and 0.714 for men and women, respectively. When either the grip strength test or 5-time chair stand test result was examined, the sensitivity of possible sarcopenia to predict sarcopenia decreased, whereas the specificity remained at 0.990-1.000 in men and 0.890-0.940 in women. An extremely decreased CC was identified as a significant characteristic of patients with sarcopenia not detected in the simplified assessment.

CONCLUSIONS

The diagnostic accuracy of possible sarcopenia for definitive sarcopenia is excellent. Sarcopenia should be actively examined in patients with extremely decreased CC.

[Characteristics of resistance training-based programs in older adults with sarcopenia: Scoping review]

OBJECTIVE

The aim of this scoping review was to analyze the resistance training-based programs' characteristics and outcomes of physical and psychological health and cognitive functions measured in older adults with sarcopenia.

METHOD

This scoping review was carried out following the criteria and flow diagram established in the PRISMA guidelines and included studies from 2011 until 2020 from electronic databases, including PubMed, Scopus, and Web of Science.

RESULTS

A total of 13 randomized controlled trials were included. The sample's average age was 72.2 years, with an age range between 71 and 80 years, considering a total sample of 1029 older adults (57% women). Resistance training-based programs were carried out mainly in university facilities, presented high adherence (91.2%) and were able to induce increase in strength and muscle mass. The most frequent parameters used were 2-3 weekly, 50-90-min-long sessions for 3-9 months, using between 8 and 15 repetitions, in an intense training zone with 1-RM between 60% and 85%. The most measured physical health outcomes were muscle strength, muscle mass, and BMI. Cognitive impairment was frequently evaluated, and few studies evaluated mental health.

CONCLUSION

This review characterized resistance training-based programs in older people with sarcopenia, highlighting the extension, frequency, duration, and intensity of these, as well the most frequently used outcome measures and instruments. These results could be useful for prescribing future resistance training-based programs in older adults with sarcopenia.

Effects and Moderators of Exercise on Sarcopenic Components in Sarcopenic Elderly: A Systematic Review and Meta-Analysis

Background: Sarcopenia is a muscle disease in loss of muscle strength, mass, and function associated with aging. Although protective effects of exercise on muscle mass and function are generally recognized, research findings in sarcopenic adults are inconsistent. It is necessary to conduct a systematic review to determine the effects of exercise on muscle strength, body composition, and physical performance in older adults with sarcopenia, and to examine the potential moderators including sociodemographic characteristics and exercise-related factors.

Methods: Six electronical academic databases (Medline, Embase, CINAHL, Scopus, Cochrane Library, and SPORTDiscus) were used to retrieve the eligible studies from inception to May 2020. Two reviewers independently selected and extracted the data from each included study, and effect sizes were calculated by employing random-effect models with 95% confidential interval (CI). The Physiotherapy Evidence Database (PEDro) scale was used to assess study quality.

Results: Seventeen studies (985 participants with sarcopenia, aged 67.6–86 years) were included in this review study. The meta-analytic results showed significant improvements in muscle strength [grip strength, SMD = 0.30, 95% CI (0.15, 0.45), I² = 6%, p < 0.01; knee extension, SMD = 0.32, 95% CI (0.15, 0.50), I² = 0%, p < 0.01; and chair and stand, SMD = 0.56, 95% CI (0.30, 0.81), I² = 36%, p < 0.01], in physical performance [timed up and go, SMD = 0.74, 95% CI (0.48, 1.00), I² = 0%, p < 0.01; and gait speed, SMD = 0.59, 95% CI (0.35, 0.82), I² = 62%, p < 0.01], and in body composition [skeletal muscle mass index, SMD = 0.37, 95% CI (0.15, 0.58), I² = 16%, p < 0.01; and appendicular skeletal muscle, SMD = 0.31, 95% CI (0.13, 0.49), I² = 20%, p < 0.01]. However, there were no significant differences in other body composition (SMD = 0.20–0.36). Additionally, meta-regression revealed that the higher percent of female participants was significantly associated with improved gait speed (β = 0.0096, p = 0.03) and decreased skeletal muscle mass index (β = −0.0092, p = 0.01).

Conclusions: The current meta-analysis suggests that exercise is a beneficial therapy, which has protective effects for older adults with sarcopenia. Some beneficial effects may be moderated by gender and exercise intensity.

Association of Oral Hypofunction with Frailty, Sarcopenia, and Mild Cognitive Impairment: A Cross-Sectional Study of Community-Dwelling Japanese Older Adults

Oral hypofunction is a new concept that addresses the oral function of older adults. Few studies have investigated the relationship between oral hypofunction and general health conditions such as frailty, sarcopenia, and mild cognitive impairment. This paper explores these relationships in a large-scale, cross-sectional cohort study. The relationships of oral hypofunction with frailty, sarcopenia, and mild cognitive impairment were examined using data from 832 individuals who participated in the 2018 health survey of the residents of Tarumizu City, Kagoshima Prefecture, Japan. Individuals with frailty, sarcopenia, and mild cognitive impairment had significantly higher rates of oral hypofunction. Frailty was independently associated with deterioration of the swallowing function (odds ratio 2.56; 95% confidence interval, 1.26-5.20), and mild cognitive impairment was independently associated with reduced occlusal force (odds ratio 1.48; 95% confidence interval, 1.05-2.08) and decreased tongue pressure (odds ratio 1.77; 95% confidence interval, 1.28-2.43). There was no independent association found between sarcopenia and oral function. In conclusion, early intervention for related factors such as deterioration of the swallowing function in frailty, reduced occlusal force, and decreased tongue pressure in mild cognitive impairment could lead to the prevention of general hypofunction in older adults.

Effects of multi-domain lifestyle interventions on sarcopenia measures and blood biomarkers: secondary analysis of a randomized controlled trial of community-dwelling pre-frail and frail older adults

Few studies have comprehensively described changes in blood biomarkers of the physiological responses underlying sarcopenia reduction associated with lifestyle interventions. In this study, we performed secondary analyses of data in a randomized controlled trial of multi-domain lifestyle interventions (6-month duration physical exercise, nutritional enrichment, cognitive training, combination and standard care control) among 246 community-dwelling pre-frail and frail elderly, aged ≥65 years, with and without sarcopenia. Appendicular lean mass (ALM), lower limb strength, gait speed, and blood levels of markers of muscle metabolism, inflammation, anti-oxidation, anabolic hormone regulation, insulin signaling, tissue oxygenation were measured at baseline, 3-month and 6-month post-intervention. Multi-domain interventions were associated with significant (p < 0.001) reduction of sarcopenia at 3-month and 6-month post-intervention, improved gait speed, enhanced lower limb strength, and were equally evident among sarcopenic participants who were slower at baseline than non-sarcopenic participants. Active intervention was associated with significantly reduced inflammation levels. Sarcopenia status and reduction were associated with blood biomarkers related to muscle metabolism, steroid hormone regulation, insulin-leptin signaling, and tissue oxygenation. Physical, nutritional and cognitive intervention was associated with measures of sarcopenia reduction, together with changes in circulating biomarkers of anabolic and catabolic metabolism underlying sarcopenia.

High-Intensity Interval Aerobic Resistance Training to Counteract Low Relative Appendicular Lean Soft Tissue Mass in Middle Age: Study Protocol for a Randomized Controlled Trial

BACKGROUND

Sarcopenia is the age-related loss of skeletal muscle mass and function and may exist in early middle age. Previous research in this area has focused on resistance training in older individuals; however, there is a lack of intervention trials in middle-aged adults with low relative appendicular lean soft tissue mass who may be at risk for sarcopenia in older age.

OBJECTIVE

This randomized controlled trial aims to determine the effects of a high-intensity interval aerobic resistance training intervention on appendicular lean soft tissue mass in middle-aged adults with low relative appendicular lean soft tissue mass.

METHODS

We will conduct a 40-week, single-blinded randomized controlled trial in 84 middle-aged adults with low appendicular lean soft tissue mass in the wider Dunedin area, New Zealand. We will randomly allocate participants to receive either a group-based, 20-week high-intensity interval aerobic resistance training intervention program or a single, 60-minute education session on current exercise recommendations. After the first 20 weeks, both groups will be given a 20-week home program. The study will assess primary and secondary outcome measures, including body composition (regional and whole-body lean soft tissue mass, fat mass, percentage body fat, measured by dual x-ray absorptiometry), blood biomarkers (cortisol, creatinine, C-reactive protein, lipid profile, hemoglobin), physical fitness (maximum oxygen consumption, blood pressure), physical activity (accelerometry), physical function (handgrip strength, sit-to-stand, gait speed, quadriceps strength), and self-reported questionnaires (health outcomes, self-efficacy, perceived enjoyment of physical activity, and multifactorial lifestyle), at baseline, 20 weeks, and 40 weeks. Physical function and self-reported questionnaires will also be measured at 10 weeks. We will assess the primary outcome measure, total body lean soft tissue mass, at baseline, 20 weeks, and 40 weeks. Analyses will be performed using intention-to-treat principles, comparing the outcomes resulting from the intervention, using linear mixed models.

RESULTS

We obtained ethical approval for this study from The University of Otago Human Ethics Committee on December 10, 2018. Participant recruitment started on February 11, 2019 and was completed on May 14, 2019. Data collection started on February 25, 2019 and was completed on February 28, 2020. We expect to publish the results in January 2021.

CONCLUSIONS

High-intensity interval aerobic resistance training is a time-efficient form of exercise, enabling busy middle-aged adults to meet physical activity recommendations while maximizing training results. The findings can inform the development of future prevention-focused interventions aimed at counteracting the high prevalence of sarcopenia in the aging population.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ACTRN12618001778279); https://tinyurl.com/y555z6fz.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/22989.