Sarcopenia與運動和營養(yǎng)干預(yù)(vi)Whatistheroleofphysicalactivityinpreventionandtreatmentofsarcopeniainolderpeople?Whatexercisesarebestsuitedandmosteffectiveforolderpeople?Howcanolderpeoplebeenabledtotakemorehabitualphysicalactivity?Howcannutritionandexerciseregimensbecombinedforpreventionoftreatmentofsarcopenia?LossofStrength:BiologicCauses

Decreaseinnumberandsizeofmusclefibers.Numberofmotorunitsdeclineswithage.AbilityofCVsystemtodeliverrawmaterialstoworkingmusclesisreduced.Reductioninglycoproteins–moredifficultfortissuestoretainnormalfluidcontent.LossofStrength:BiologicCauses

Decreaseinefficiencyofmusclecells’selectivelypermeablemembrane.Concentrationofpotassiumisparticularlyreduced.Reducesmaximumforceofcontraction.Othernutritionrelatedeffects:VitaminCandZincClinicalimplications?

LossofStrength:FunctionalCausesDeclineinstrengthwithagelargelyduetodecreasedactivity.Mostaffectedareanti-gravitymuscles:quads,hipextensors,ankledorsiflexors,andtriceps.Functionalstrengthassessment:HandhelddynamometryBicepscurlsSit-to-standtestLossofStrength:PathologicCausesNumerousstrength-alteringdiseasesPolymyalgiarheumaticaSyndromeoccurringinolderindividualsCharacterizedbypain,weakness,andstiffnessinproximalmusclegroups(neck,back,pelvicandshouldergirdles)Alsofever,malaise,weightloss,veryrapidsedrateRespondsdramaticallytocorticosteroidtherapySarcopeniacategoriesbycausePrimarysarcopeniaAge-relatedNoothercauseevidentexceptageingsarcopeniaSecondarysarcopeniaActivity-relatedsarcopeniaCanresultfrombedrest,sedentarylifestyle,deconditioningorzero-gravityconditionsDisease-relatedsarcopeniaAssociatedwithadvancedorganfailure(heart,lung,liver,kidney,brain),inflammatorydisease,malignancyorendocrinediseaseNutrition-relatedsarcopeniaResultsfrominadequatedietaryintakeofenergyand/orprotein,aswithmalabsorption,gastrointestinaldisordersoruseofmedicationsthatcauseanorexiaMeasurementsofmusclemass,strength,and

functioninresearchandpractice

VariableResearchClinicalpracticeMusclemassComputedtomography(CT)BIAMagneticresonanceimaging(MRI)DXADualenergyX-rayabsorptiometry(DXA)AnthropometryBioimpedanceanalysis(BIA)Totalorpartialbodypotassiumperfat-freesofttissueMusclestrengthHandgripstrengthHandgripstrengthKneeflexion/extensionPeakexpiratoryflowPhysicalperformanceShortPhysicalPerformanceSPPBBattery（SPPB)UsualgaitspeedUsualgaitspeedGet-up-and-gotestTimedget-up-and-gotestStairclimbpowertestSittoStandTestforLEStrength#repetitionsin30secondsNormsforelders:Women60-64,12-17reps90-94,4-11repsMen60-64,14-19reps90-94,7-12repsSuggestedprimaryandsecondaryoutcomedomainsforinterventiontrialsinsarcopenia

Primaryoutcomedomains?Physicalperformance?Musclestrength?MusclemassSecondaryoutcomedomains?Activitiesofdailyliving(ADL;basic,instrumental)?Qualityoflife(QOL)?Metabolicandbiochemicalmarkers?Markersofinflammation?Globalimpressionofchangebysubjectorphysician?Falls?Admissiontonursinghomeorhospital?Socialsupport?MortalityLowprotein+lowexercise=sarcopeniaCalculating1RM

StrengtheningSeniors

Evidence-basedExaminationandExercisePrescriptionSectiononGeriatrics,APTAIntensityHigh60-80%1RM:8-12repstofatigueMosthealthyagingadultscando70-80%Low30-50%1RM:12-25repstofatigueBetterforthosewith:MI<6wksProgressiveneurodisorders(eg.MS)AcutemusculoskeletalconditionsandhealingtissuesVeryfrailordeconditionedindividualsStrengtheningSeniorsIntensitySlowmovement:“stoponadime”Full,pain-freeROMGoodformandtechnique70-80%RPE“somewhathard”to“hard”30-60%RPE“fairlylight”to“somewhathard”StrengtheningSeniorsProgression30-60%1RM<25reps,sameresistance>25reps,increaseresistance10%70-80%1RM<12reps,sameresistance>12reps,increaseresistance5%Frequency2-3timesperweekNutritionandSarcopeniaShort-TermCalorieRestrictionEnhancesSkeletalMuscleStemCellFunctionCRincreasesskeletalmusclestemcellfrequencyinyoungandagedmiceMusclestemcellsfromCR-treatedmiceshowincreasedabundanceofmitochondriaCRimprovesmuscleregenerationandenhancesstemcelltransplantefficiency

Proteinprovidesaminoacidshaveastimulatoryeffectonmuscleproteinsynthesis

VitaminDAntioxidantNutrientsLong-ChainPolyunsaturatedFattyAcids(LCPUFAs)

FoodsandDietaryPatterns2臨床表現(xiàn)

①體力活動降低：隨著年齡的增長，人體下肢功能逐漸減退，這種下肢功能降低的主要原因并非是肌肉數(shù)量的減少，而是由于肌力的下降。②情緒障礙：骨骼肌功能的退化影響老年人的體力狀況，使老年人的心理狀態(tài)失常，并相繼出現(xiàn)焦慮、抑郁等情緒波動。③誘發(fā)骨質(zhì)疏松：骨骼所承受的負荷主要來自于肌肉的主動收縮，而非體重，老年人的肌力呈衰退狀態(tài)，骨強度稍大于肌力，骨骼相對處于廢用狀態(tài)肌少癥應(yīng)是老年個體的多重變化加乘所引起的：(1)年齡造成的肌肉神經(jīng)組織變化，加上相關(guān)賀爾蒙量（testosterone,growthhormone）的減少；(2)營養(yǎng)相關(guān)的變化－主因於蛋白質(zhì)和能量的攝取不足或吸收不良，加上腸胃道及用藥等問題；(3)相關(guān)疾病造成的發(fā)炎、器官損傷、臥床等；(4)活動量減少甚至不活動造成的肌肉流失。因此，對於肌少癥的防治，除疾病造成的原因應(yīng)先消除外，運動訓(xùn)練搭配適當(dāng)營養(yǎng)補充（主為蛋白質(zhì)），目前被認為是具成效的。然而哪些運動細節(jié)及如何補充？在運動前中後？……，都需進一步研究。

肌肉減少癥(Sarcopenia)最早由EvansWJ和RosenbergIR于1991年提出,形容骨骼肌減少,同時泛指骨骼肌細胞去神經(jīng)支配、線粒體功能障礙、炎性、激素合成及分泌改變以及由以上過程引發(fā)的一系列后果,如肌力下Sarcopenia

Agradualwastingofmuscletissue.Beginsshortlyafterage20andaccelerates