Sarcopenia PDF

MUSCULOSKELETAL CONDITIONS: SARCOPENIA  Sarcopenia 1 Overview 2 Management Interventions 3 Future Implications  1 Sarcopenia: Overview Sarcopenia: Overview The number of adults aged 65 years and older is projected to double in size by 2060 (Vespa et al., 2020) Life...

MUSCULOSKELETAL CONDITIONS: SARCOPENIA  Sarcopenia 1 Overview 2 Management Interventions 3 Future Implications  1 Sarcopenia: Overview Sarcopenia: Overview The number of adults aged 65 years and older is projected to double in size by 2060 (Vespa et al., 2020) Life expectancy for the total population is projected to rise from 79.7 years in 2017 to 85.6 years in 2060 (Medina et al., 2018). 85% of adults aged 65 years and older have at least one chronic disease (National Center for Chronic Disease Prevention and Health Promotion, 2022)  “No decline with age is more dramatic or potentially more functionally significant than the decline in lean body mass. […] Why have we not given it more attention?” —Irwin Rosenberg  Sarcopenia: Overview Loss of Imaging Techniques muscle mass Anthropometric Measures Sarcopenia Loss of Hand grip strength strength Chair stand test Loss of SARC-F Muscle- Gait Speed, Short Physical specific Performance Battery, Timed Up & strength Go  Sarcopenia: Risk Factors A multifactorial geriatric syndrome Age Sex Health Status Ethnicity Genetic Gut Region Behavioral Factors Microbiome Factors Social Psychological Biochemical Other Factors Factors Factors Comorbidities  Sarcopenia: Etiology Age-related effects on muscle Changes in muscle Neuromuscular Increase in adipose Impaired muscle fiber composition junction tissue protein turnover insufficiency Metabolic Altered endocrine Growth factor Altered muscle dysregulation function imbalances quality  Sarcopenia: Etiology Age-related effects on muscle mass One estimate of loss of peak muscle mass per decade in humans includes 4.7% for males and 3.7% for females (Mitchell et al., 2012) (Sayer et al., 2008)  Sarcopenia: Etiology Age-related effects on muscle mass Approximately 30% of an individual’s peak muscle mass is lost by the age of 80 Muscle mass is lost at a rate of 0.64–0.70% per year in women and 0.80–00.98% per year in men over 75 years of age Sarcopenia: Age-related effects on muscle mass (McLeod et al., 2016)  Sarcopenia: Etiology Age-related effects on muscle mass (Lee et al., 2006)  Sarcopenia: Etiology Qualitative changes of muscle fibers ↓ force- generating ↓ maximum velocity of contractile elements in the muscle fiber the muscle shortening capability ↓ myosin-based actin ↑ hypoplasia of Type IIa sliding velocity in and Type IIx muscle fibers fast-twitch muscle fibers Sarcopenia: Age-related effects on muscle strength and physical performance The rate in which older adults lose Relative STS power decreased muscle strength is approximately two significantly after the age of 50 years to five times faster than the loss of muscle mass and was negatively and strongly associated with mobility limitations. Loss of muscle strength occurs around 60 years of age Decreased physical performance (gait Muscle strength is lost at a rate of 3–4% speed) occurs around 70 years of age per year in men and 2.5–3% per year in women over 75 years of age Alcazar et al., 2021 Mitchell et al., 2012 Sarcopenia: Prevalence and Financial Trends 9.9-40.4% $40 billion The burden of sarcopenia-associated Prevalence of sarcopenia in disability with regards to hospitalizations community-dwelling older adults in a five year period (Mayhew et al., 2019) (Goates et al., 2019) $65/487 billion 34% The projected amount of savings by Increase in hospital costs for sarcopenia reducing the severity of sarcopenia in patients aged 65 years and older older adults by 2040 (MacEwan et al., (Sousa et al., 2016) 2018)  Sarcopenia: Etiology Impact on health outcomes Chronic disease Falls and fractures Mortality Patient-reported outcomes Sarcopenia: Impact on Health Outcomes Yeung et al. (2019) Beaudart et al. (2019) Trombetti et al. (2016) Three-year longitudinal study Systematic review of 33 Ten out of twelve studies demonstrated that declines in studies which analyzed reporting mortality data muscle mass and physical sarcopenic individuals with a indicated an ASSOCIATION performance were mean or median age > 65 BETWEEN SARCOPENIA AND independently associated with years MORTALITY DECREASING QUALITY OF LIFE Reduced muscle mass, Results revealed a POSITIVE Sarcopenic patients were 4 strength, power, and physical ASSOCIATION BETWEEN times more likely to die than performance contributed SARCOPENIA, FALLS, AND non-sarcopenic subjects. independently to an FRACTURES INCREASED FEAR OF FALLING  2 Sarcopenia: Management Interventions Sarcopenia: Management interventions Sarcopenia Pharmacological Physical activity Nutrition Sarcopenia: Management interventions Sarcopenia: Management interventions The average food consumption is estimated to drop by approximately 25% between the ages of 40 and 70 Malnutrition Increase adiposity Dehydration (Calvani et al., 2023) Sarcopenia: Management interventions Exercise Sarcopenia: Resistance Exercise ↑ muscle hypertrophy ↑ protein synthesis ↑ activation of muscle satellite cells ↑ myofibrillar density ↑ stimulation of the biogenesis of mitochondria in the muscle cells ↑ in growth hormones Improves neural adaptations Improves insulin sensitivity Changes in muscle fiber type distribution such as increase in Type II fibers Induces adaptation of connective tissue Sarcopenia: Resistance Exercise (Cannataro et al., 2022) Sarcopenia: Resistance Exercise (Hurst et al., 2022) Training Exercise Exercise Exercise volume Rest Periods frequency selection intensity Chest 40–60% 1RM Within session press 1–3 sets of 6–12 2x/week progressing to 60–120 s between sets; 3–5 Seated row 70–85% 1RM repetitions min between exercises Pull down Squat/leg press RPE 3–5 on CR10 Knee Between sessions scale progressing extension to RPE 6–8 At least 48 h Leg curl Calf raise Sarcopenia: Resistance Exercise Overload Responses to exercise training are specific to the stimulus induced by the exercise dose. Specificity A greater than habitual stress or load on the body is needed to induce adaptation. Progression A gradual and systematic increase in stress placed on the body is necessary to induce continual training adaptation over time. Effects of Resistance Training on Muscle Size and Strength in Very Elderly Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials (Grgic et al., 2020) Very elderly adults (over 75 years of age)can increase their muscle strength and size by participating in resistance training programs. These effects were observed with resistance training interventions that generally included low weekly training volumes and frequencies. There were minimal reports of adverse events associated with the training programs. Sarcopenia: Aerobic, balance & flexibility exercise Aerobic Balance Flexibility Improves aerobic capacity Neuromotor training Gao et al. (2023) Improves metabolic Dual-task training demonstrated that regulation Speed, agility & high flexibility was Improves cardiovascular quickness associated with function Beckwée et al. (2019) reduced risk of Induces mitochondrial found incident low muscle biogenesis and dynamics, multicomponent mass, muscle training improved to the restoration of strength, and muscle mass, muscle mitochondrial metabolism strength, and physical sarcopenia Reduces the expressions performance in Minimizes mobility of catabolic genes sarcopenic older deficits experienced Increases muscle protein adults with aging synthesis May improve postural stability and balance (Kumar et al., 2022) Sarcopenia: Future Implications 3 Sarcopenia: Future Implications A one-hour increase in sedentary behavior per day was associated with 1.06 times higher odds for sarcopenia (Smith et al., 2020)  Sarcopenia: Future Implications The prevalence of active adults from 2017-2020 in the United States was 25.3 % (Centers of Disease Control and Prevention, 2022) Increase in the prevalence of adults aged 50 years and older with multiple chronic conditions is expected by the year 2050 (Ansah & Chiu, 2022)  Sarcopenia: Future Implications 2022 Behavioral Risk Factor Surveillance System data revealed that 27.5% of older adults in the United States reported having a mobility disability (U.S. Department of Health and Human Services, 2024) Population Aging Chronic Disease Sarcopenia  Sarcopenia: Future Implications The number of adults aged 85 Exercise prescription must address years and older will double by the Global Leadership Initiative improving muscle size, strength year 2035 and nearly triple by the on Sarcopenia and power at an earlier age year 2060. WHO Measurement of Pharmacological Artificial Intelligence and Healthy Ageing (2023) Interventions muscle health  Sarcopenia: Future Implications WHO Measurement of Healthy Ageing (2023) In its 2015 World Report on Ageing and Health, WHO defined healthy ageing as ‘the process of developing and maintaining the functional ability that enables wellbeing in older age’ The World Report on Ageing and Health defines functional ability as the ‘capability that enables people to be and do what they have reason to value’, with domains of meeting basic needs; ability to learn, grow and make decisions; being mobile; building and maintaining relationships; and contributing to society Functional ability results from an interaction between basic components of ‘intrinsic capacity’ (mobility, cognition, sensory function, psychology and vitality) and the physical and social environment in which an individual lives References Alcazar, J., Alegre, L. M., Van Roie, E., Magalhães, J. P., Nielsen, B. 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