sarcopenia与运动干预

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。,Mechanismsofsarcopenia,LossofStrength:BiologicCauses,Decreaseinnumberandsizeofmusclefibers.Numberofmotorunitsdeclineswithage.AbilityofCVsystemtodeliverrawmaterialstoworkingmusclesisreduced.Reductioninglycoproteinsmoredifficultfortissuestoretainnormalfluidcontent.,LossofStrength:BiologicCauses,Decreaseinefficiencyofmusclecellsselectivelypermeablemembrane.Concentrationofpotassiumisparticularlyreduced.Reducesmaximumforceofcontraction.Othernutritionrelatedeffects:VitaminCandZincClinicalimplications?,LossofStrength:FunctionalCauses,Declineinstrengthwithagelargelyduetodecreasedactivity.Mostaffectedareanti-gravitymuscles:quads,hipextensors,ankledorsiflexors,andtriceps.Functionalstrengthassessment:HandhelddynamometryBicepscurlsSit-to-standtest,LossofStrength:PathologicCauses,Numerousstrength-alteringdiseasesPolymyalgiarheumaticaSyndromeoccurringinolderindividualsCharacterizedbypain,weakness,andstiffnessinproximalmusclegroups(neck,back,pelvicandshouldergirdles)Alsofever,malaise,weightloss,veryrapidsedrateRespondsdramaticallytocorticosteroidtherapy,Sarcopeniacategoriesbycause,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,andfunctioninresearchandpractice,SittoStandTestforLEStrength,#repetitionsin30secondsNormsforelders:Women60-64,12-17reps90-94,4-11repsMen60-64,14-19reps90-94,7-12reps,EWGSOP-suggestedalgorithmforsarcopeniacasefindinginolderindividuals,EWGSOP（EuropeanWorkingGrouponSarcopeniainOlderPeople),Suggestedprimaryandsecondaryoutcomedomainsforinterventiontrialsinsarcopenia,PrimaryoutcomedomainsPhysicalperformanceMusclestrengthMusclemassSecondaryoutcomedomainsActivitiesofdailyliving(ADL;basic,instrumental)Qualityoflife(QOL)MetabolicandbiochemicalmarkersMarkersofinflammationGlobalimpressionofchangebysubjectorphysicianFallsAdmissiontonursinghomeorhospitalSocialsupportMortality,Lowprotein+lowexercise=sarcopenia,ExerciseandSarcopeniaStrength:ClinicalImplications,Functionalstrength-training1RepetitionMaximum(1RM)Exerciseat60-80%of1RM1setof8-12reps*2-3timesperweekIncreaseweight10-15%perweekSuggestedtiming:2-3secondlift,4-6secondlower*Starckey,D,etal.:Effectofresistancetrainingvolumeonstrengthandmusclethickness.MedSciSportsExerc28(10):1311-20,1996.,Calculating1RM,StrengtheningSeniorsEvidence-basedExaminationandExercisePrescriptionSectiononGeriatrics,APTA,IntensityHigh60-80%1RM:8-12repstofatigueMosthealthyagingadultscando70-80%Low30-50%1RM:12-25repstofatigueBetterforthosewith:MI6wksProgressiveneurodisorders(eg.MS)AcutemusculoskeletalconditionsandhealingtissuesVeryfrailordeconditionedindividuals,StrengtheningSeniors,IntensitySlowmovement:“stoponadime”Full,pain-freeROMGoodformandtechnique70-80%RPE“somewhathard”to“hard”30-60%RPE“fairlylight”to“somewhathard”,StrengtheningSeniors,DurationRepstofatigueSpeedincreasesFormdeterioratesFailstocompleteROMWatchfor:LookofconcentrationSlighttremorMildincreaseinrespiration,StrengtheningSeniors,Progression30-60%1RM25reps,increaseresistance10%70-80%1RM12reps,increaseresistance5%Frequency2-3timesperweek,NutritionandSarcopenia,Short-TermCalorieRestrictionEnhancesSkeletalMuscleStemCellFunctionCRincreasesskeletalmusclestemcellfrequencyinyoungandagedmiceMusclestemcellsfromCR-treatedmiceshowincreasedabundanceofmitochondriaCRimprovesmuscleregenerationandenhancesstemcelltransplantefficiency,Proteinprovidesaminoacidshaveastimulatoryeffectonmuscleproteinsynthesis,VitaminD,AntioxidantNutrients,Long-ChainPolyunsaturatedFattyAcids(LCPUFAs),FoodsandDietaryPatterns,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,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,growthhormone）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。,肌肉减少症(Sarcopenia)最早由EvansWJ和RosenbergIR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以上过程引发的一系列后果,如肌力下,Sarcopenia,Agradualwastingofmuscletissue.Beginsshortlyafterage20andacceleratesafterage50.In1999,theCDC(CentersforDiseaseControl)recognizedsarcopeniaasoneofthetop5majorhealthrisksfacingtheUSpopulation.,Strength-trainingStudy:,Youngerandoldermen2monthquadstrength-trainingBothgroupsincreasedtosameleve