sarcopenia与运动和营养干预ppt课件

Sarcopenia与运动和营养干预 n (i) What is sarcopenia? (ii) What parameters define sarcopenia? (iii) What variables reflect these parameters, and what measurement tools and cut-off points can be used? (iv) How does sarcopenia relate to cachexia, frailty and sarcopenic obesity? (v) What is the role of nutrition in prevention and treatment of age-related sarcopenia? What amounts of macronutrients are needed for older people with or at risk for sarcopenia, especially protein and specific amino acids? What micronutrients, e.g. vitamin D, play important roles in protecting and building lean body mass? n (vi) What is the role of physical activity in prevention and treatment of sarcopenia in older people? What exercises are best suited and most effective for older people? How can older people be enabled to take more habitual physical activity? How can nutrition and exercise regimens be combined for prevention of treatment of sarcopenia? Sarcopenia这个词起源于希腊语，原意是 “poverty of flesh”(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。 n 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。 Mechanisms of sarcopenia Loss of Strength: Biologic Causes n Decrease in number and size of muscle fibers. n Number of motor units declines with age. n Ability of CV system to deliver raw materials to working muscles is reduced. n Reduction in glycoproteins more difficult for tissues to retain normal fluid content. Loss of Strength: Biologic Causes n Decrease in efficiency of muscle cells selectively permeable membrane. n Concentration of potassium is particularly reduced. n Reduces maximum force of contraction. n Other nutrition related effects: Vitamin C and Zinc n Clinical implications? Loss of Strength: Functional Causes n Decline in strength with age largely due to decreased activity. n Most affected are anti-gravity muscles: quads, hip extensors, ankle dorsiflexors, and triceps. n Functional strength assessment: n Handheld dynamometry n Biceps curls n Sit-to-stand test Loss of Strength: Pathologic Causes n Numerous strength-altering diseases n Polymyalgia rheumatica n Syndrome occurring in older individuals n Characterized by pain, weakness, and stiffness in proximal muscle groups (neck, back, pelvic and shoulder girdles) n Also fever, malaise, weight loss, very rapid sed rate n Responds dramatically to corticosteroid therapy Sarcopenia categories by cause Primary sarcopenia Age-related No other cause evident except ageing sarcopenia Secondary sarcopenia Activity-related sarcopenia Can result from bed rest, sedentary lifestyle, deconditioning or zero-gravity conditions Disease-related sarcopenia Associated with advanced organ failure (heart, lung, liver, kidney, brain), inflammatory disease, malignancy or endocrine disease Nutrition-related sarcopenia Results from inadequate dietary intake of energy and/or protein, as with malabsorption, gastrointestinal disorders or use of medications that cause anorexia 肌少症的诊断及分级标准 Criteria for the diagnosis of sarcopenia n 1、低肌肉质量（ Low muscle mass） n 2、低肌肉力量（ Low muscle strength） n 3、低身体功能表现（ Low physical performance） Diagnosis is based on documentation of criterion 1 plus (criterion 2 or criterion 3) Measurements of muscle mass, strength, and function in research and practiceVariable Research Clinical practice Muscle mass Computed tomography (CT) BIA Magnetic resonance imaging (MRI) DXA Dual energy X-ray absorptiometry (DXA) Anthropometry Bioimpedance analysis (BIA) Total or partial body potassium per fat-free soft tissue Muscle strength Handgrip strength Handgrip strength Knee flexion/extension Peak expiratory flow Physical performance Short Physical Performance SPPB Battery （ SPPB) Usual gait speed Usual gait speed Get-up-and-go test Timed get-up-and-go test Stair climb power test Sit to Stand Test for LE Strength n # repetitions in 30 seconds n Norms for elders: n Women 60-64, 12-17 reps n 90-94, 4-11 reps n Men 60-64, 14-19 reps n 90-94, 7-12 reps EWGSOP-suggested algorithm for sarcopenia case finding in older individuals n EWGSOP（ European Working Group on Sarcopenia in Older People ) Suggested primary and secondary outcome domains for intervention trials in sarcopenia Primary outcome domains Physical performance Muscle strength Muscle mass Secondary outcome domains Activities of daily living (ADL; basic, instrumental) Quality of life (QOL) Metabolic and biochemical markers Markers of inflammation Global impression of change by subject or physician Falls Admission to nursing home or hospital Social support Mortality Low protein + low exercise=sarcopenia Exercise and Sarcopenia Strength: Clinical Implications n Functional strength-training n 1 Repetition Maximum (1RM) n Exercise at 60-80% of 1 RM n 1 set of 8-12 reps* n 2-3 times per week n Increase weight 10-15% per week n Suggested timing: 2-3 second lift, 4-6 second lower n *Starckey, D, et al.: Effect of resistance training volume on strength and muscle thickness. Med Sci Sports Exerc 28(10):1311-20, 1996. Calculating 1RM Strengthening Seniors Evidence-based Examination and Exercise Prescription Section on Geriatrics, APTA n Intensity n High 60-80% 1 RM: 8-12 reps to fatigue n Most healthy aging adults can do 70-80% n Low 30-50% 1 RM: 12-25 reps to fatigue n Better for those with: n MI 25 reps, increase resistance 10% n 70-80% 1RM n 12 reps, increase resistance 5% n Frequency n 2-3 times per week Nutrition and Sarcopenia n Short-Term Calorie Restriction Enhances Skeletal Muscle Stem Cell Function n CR increases skeletal muscle stem cell frequency in young and aged mice n Muscle stem cells from CR- treated mice show increased abundance of mitochondria n CR improves muscle regeneration and enhances stem cell transplant efficiency n Protein n provides amino acids n have a stimulatory effect on muscle protein synthesis n Vitamin D n Antioxidant Nutrients n Long-Chain Polyunsaturated Fatty Acids (LCPUFAs) n Foods and Dietary Patterns n 2 临床表现 体力活动降低：随着年龄的增长，人体下 肢功能逐渐减退，这种下肢功能降低的主要原 因并非是肌肉数量的减少，而是由于肌力的下 降。 情绪障碍：骨骼肌功能的退化影响老年 人的体力状况，使老年人的心理状态失常，并 相继出现焦虑、抑郁等情绪波动。 诱发骨质 疏松：骨骼所承受的负荷主要来自于肌肉的主 动收缩，而非体重，老年人的肌力呈衰退状态 ，骨强度稍大于肌力，骨骼相对处于废用状态 n 肌少症應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組織變化，加上相關賀爾蒙 量（ testosterone, growth hormone）的減少； ( 2 ) 營養相關的變化主因於蛋白質和能量的攝取不足 或吸收不良，加上腸胃道及用藥等問題； ( 3 ) 相關 疾病造成的發炎、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 症的防治，除疾病造成的原因應先消除外，運動訓 練搭配適當營養補充（主為蛋白質），目前被認為 是具成效的。然而哪些運動細節及如何補充？在運 動前中後？ ，都需進一步研究。 n n 肌肉减少症 (Sarcopenia)最早由 Evans WJ和 Rosenberg IR于 1991年提出 ,形容骨骼肌减 少 ,同时泛指骨骼肌细胞去神经支配、线粒 体功能障碍、炎性、激素合成及分泌改变 以及由