搜索
Sarcopenia与运动和营养干预•(i)Whatissarcopenia?•(ii)Whatparametersdefinesarcopenia?•(iii)Whatvariablesreflecttheseparameters,andwhatmeasurementtoolsandcut-offpointscanbeused?•(iv)Howdoessarcopeniarelatetocachexia,frailtyandsarcopenicobesity?•(v)Whatistheroleofnutritioninpreventionandtreatmentofage-relatedsarcopenia?Whatamountsofmacronutrientsareneededforolderpeoplewithoratriskforsarcopenia,especiallyproteinandspecificaminoacids?Whatmicronutrients,e.g.vitaminD,playimportantrolesinprotectingandbuildingleanbodymass?•(vi)Whatistheroleofphysicalactivityinpreventionandtreatmentofsarcopeniainolderpeople?Whatexercisesarebestsuitedandmosteffectiveforolderpeople?Howcanolderpeoplebeenabledtotakemorehabitualphysicalactivity?Howcannutritionandexerciseregimensbecombinedforpreventionoftreatmentofsarcopenia?Sarcopenia这个词起源于希腊语，原意是“povertyofflesh”(缺少肌肉)。“Sarco”是前缀，指肌肉；“penia”是后缀，意流失。国内文献译为“少肌症”、“骨骼肌减少症”、“肌肉衰减征”、“老年性骨骼肌减少症”等等。在1989年由Irwin第一次用来描述老年性的肌肉减少和力量衰减。•2010年，Sarcopenia欧洲工作组(EWGSOP)将少肌症定义为：“老年人骨骼肌质量和骨骼肌力量及功能下降的一种病征”，主要强调骨骼肌量下降，或加上骨骼肌力量下降，或再加上骨骼肌功能下降。MechanismsofsarcopeniaLossofStrength:BiologicCauses•Decreaseinnumberandsizeofmusclefibers.•Numberofmotorunitsdeclineswithage.•AbilityofCVsystemtodeliverrawmaterialstoworkingmusclesisreduced.•Reductioninglycoproteins–moredifficultfortissuestoretainnormalfluidcontent.LossofStrength:BiologicCauses•Decreaseinefficiencyofmusclecells’selectivelypermeablemembrane.•Concentrationofpotassiumisparticularlyreduced.•Reducesmaximumforceofcontraction.•Othernutritionrelatedeffects:VitaminCandZinc•Clinicalimplications?LossofStrength:FunctionalCauses•Declineinstrengthwithagelargelyduetodecreasedactivity.•Mostaffectedareanti-gravitymuscles:quads,hipextensors,ankledorsiflexors,andtriceps.•Functionalstrengthassessment:–Handhelddynamometry–Bicepscurls–Sit-to-standtestLossofStrength:PathologicCauses•Numerousstrength-alteringdiseases•Polymyalgiarheumatica–Syndromeoccurringinolderindividuals–Characterizedbypain,weakness,andstiffnessinproximalmusclegroups(neck,back,pelvicandshouldergirdles)–Alsofever,malaise,weightloss,veryrapidsedrate–RespondsdramaticallytocorticosteroidtherapySarcopeniacategoriesbycausePrimarysarcopeniaAge-relatedNoothercauseevidentexceptageingsarcopeniaSecondarysarcopeniaActivity-relatedsarcopeniaCanresultfrombedrest,sedentarylifestyle,deconditioningorzero-gravityconditionsDisease-relatedsarcopeniaAssociatedwithadvancedorganfailure(heart,lung,liver,kidney,brain),inflammatorydisease,malignancyorendocrinediseaseNutrition-relatedsarcopeniaResultsfrominadequatedietaryintakeofenergyand/orprotein,aswithmalabsorption,gastrointestinaldisordersoruseofmedicationsthatcauseanorexia肌少症的诊断及分级标准Criteriaforthediagnosisofsarcopenia•1、低肌肉质量（Lowmusclemass）•2、低肌肉力量（Lowmusclestrength）•3、低身体功能表现（Lowphysicalperformance）Diagnosisisbasedondocumentationofcriterion1plus(criterion2orcriterion3)Measurementsofmusclemass,strength,andfunctioninresearchandpracticeVariableResearchClinicalpracticeMusclemassComputedtomography(CT)BIAMagneticresonanceimaging(MRI)DXADualenergyX-rayabsorptiometry(DXA)AnthropometryBioimpedanceanalysis(BIA)Totalorpartialbodypotassiumperfat-freesofttissueMusclestrengthHandgripstrengthHandgripstrengthKneeflexion/extensionPeakexpiratoryflowPhysicalperformanceShortPhysicalPerformanceSPPBBattery（SPPB)UsualgaitspeedUsualgaitspeedGet-up-and-gotestTimedget-up-and-gotestStairclimbpowertestSittoStandTestforLEStrength•#repetitionsin30seconds•Normsforelders:–Women60-64,12-17reps–90-94,4-11reps–Men60-64,14-19reps–90-94,7-12repsEWGSOP-suggestedalgorithmforsarcopeniacasefindinginolderindividuals•EWGSOP（EuropeanWorkingGrouponSarcopeniainOlderPeople)SuggestedprimaryandsecondaryoutcomedomainsforinterventiontrialsinsarcopeniaPrimaryoutcomedomains•Physicalperformance•Musclestrength•MusclemassSecondaryoutcomedomains•Activitiesofdailyliving(ADL;basic,instrumental)•Qualityoflife(QOL)•Metabolicandbiochemicalmarkers•Markersofinflammation•Globalimpressionofchangebysubjectorphysician•Falls•Admissiontonursinghomeorhospital•Socialsupport•MortalityLowprotein+lowexercise=sarcopeniaExerciseandSarcopeniaStrength:ClinicalImplications•Functionalstrength-training•1RepetitionMaximum(1RM)–Exerciseat60-80%of1RM–1setof8-12reps*–2-3timesperweek–Increaseweight10-15%perweek–Suggestedtiming:2-3secondlift,4-6secondlower•*Starckey,D,etal.:Effectofresistancetrainingvolumeonstrengthandmusclethickness.MedSciSportsExerc28(10):1311-20,1996.Calculating1RMStrengtheningSeniorsEvidence-basedExaminationandExercisePrescriptionSectiononGeriatrics,APTA•Intensity•High60-80%1RM:8-12repstofatigue–Mosthealthyagingadultscando70-80%•Low30-50%1RM:12-25repstofatigue–Betterforthosewith:•MI6wks•Progressiveneurodisorders(eg.MS)•Acutemusculoskeletalconditionsandhealingtissues•VeryfrailordeconditionedindividualsStrengtheningSeniors•Intensity–Slowmovement:“stoponadime”–Full,pain-freeROM–Goodformandtechnique–70-80%RPE“somewhathard”to“hard”–30-60%RPE“fairlylight”to“somewhathard”StrengtheningSeniors•Duration–Repstofatigue•Speedincreases•Formdeteriorates•Failstocomplete