Transcript Therapeutic Exercise in People with Sarcopenia

Exercise in People with Frailty
Syndroms
Frailty syndrome (衰弱綜合症)
is a collection of symptoms or markers,
primarily due to the aging-related loss and
dysfunction of skeletal muscle and bone, that
place (mostly) older adults at increased risk of
adverse events such as death, disability, and
institutionalization
Sarcopenia
from the Greek meaning “poverty of flesh”
is the degenerative loss of skeletal muscle
mass and strength associated with aging (0.51% loss per year after the age of 25).
this loss of muscle mass may be caused by
different cellular mechanisms than those which
cause muscle atrophy
Than there is a replacement of muscle fibres
with fat and an increase in fibrosis
Muscle Structure and Atrophy
is a debilitating process that results in an
extensive loss of muscle function and mass
resulting in worsening of quality of life. It can
take place with aging and inadequate food
intake; it may also develop as a result of nerve
injury
Some of the treatments, such as anabolic
steroids (testosterone) and insulin-like growth
factor 1 (IFG-1), raise concerns about safety
and effectiveness
Researchers discovered that des-acyl ghrelin
has a direct anti-atrophic activity on the
skeletal muscle of mice with muscular atrophy
caused by either denervation (nerve injury) or
fasting
Pathology
Fiber-type changes in sarcopenia
– During sarcopenia, there is a decrease in "type 2" fiber
circumference (Type II), with little to no decrease in
"type I" fiber circumference (Type I).
Loss of satellite cell function
– sarcopenia, is in part caused by a failure in satellite
cell activation.the ability to repair damaged muscles or
respond to nutritional signals is impaired.
Loss of anabolic signals
– Extreme muscle loss is often a result of both
diminishing anabolic signals, such as growth hormone
and testosterone, and promotion of catabolic signals,
such as pro-inflammatory cytokines
Diagnosis
1) A low muscle mass, >2 standard deviations
below that mean measured in young adults
(aged 18–39 years in the 3rd NHANES
population) of the same sex and ethnic
background, and
2) Low gait speed (e.g. a walking speed below
0.8 m/s in the 4-m walking test).
Management
Drugs
– Testosterone, anabolic steroids, Human Growth
hormone, DHES, and non-steroid androgen
receptor modulators (SARMs)
Diet Nutrition
– An extract (EGb 761) from the plant Ginkgo
biloba (added to drinking water) was shown to
reduce the muscle loss in a rat
Exercise
– Body’s function depends on regular and
lifelong exercise to maintain integrity
– increases in activity have been shown to be
beneficial in settings of sarcopenia; exercise
even in the very old can increase strength
and muscle function.
– Lack of exercise is currently thought to be a
significant risk factor, increasing the
likelihood of sarcopenia
Osteoporosis
In osteoporosis the bone mineral density
(BMD) is reduced,
Bone microarchitecture is disrupted,
And the amount and variety of proteins in bone
is altered
a portion of a bone showing signs of
osteoporosis (right) is contrasted with
a portion of a healthy bone (left).
Estrogen's most
important effect on
osteoporosis appears to
be prevention of bone
breakdown, known as
resorption.
Healthy bones require a
balance of osteoclasts
(cells that breakdown
bones) and osteoblasts
(cells that make new
bone)
As estrogen levels
diminish, osteoclasts
live longer than their
counterparts, osteoblasts.
This leads to bones
being broken down at a
rate much greater than
they can be rebuilt, thus
they grow weak and
brittle.
Other Causes of Osteoporosis
Diseases: many diseases can hamper the
growth of new bone material. hyperthyroidism,
disorders of the adrenal glands and pituitary
gland, diabetes, and eating disorders.
Medications: some medications can reduce
bones ability to rebuild themselves. They are
glucocorticoid medications, prednisolone,
excess thyroid hormone replacement, the blood
thinner heparin, and certain anti-convulsant
medications.
Insufficient bone growth as a youth: Bones
that didn’t get enough calcium early in life have
a higher likelihood of becoming osteoporotic
and fracturing as estrogen levels begin to
decrease.
Genetic factors: If a woman’s family members,
especially her mother, have suffered from
osteoporosis, the likelihood that she will
develop the disease jumps dramatically.
Genetics also helps determine the body type of a
woman. If she inherited a small, thin body type,
she is predisposed to osteoporosis.
Benefit of Exercise
One of the best ways to strengthen your
bones and prevent osteoporosis is by
getting regular exercise. Even if you already
have osteoporosis, exercising can help
maintain the bone mass you have.
Weight-bearing Exercise for
Osteoporosis
Weight-bearing means one’s feet and legs
support the body’s weight.
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Walking
Hiking
Dancing
Stair climbing
Walking as little as three to five miles a week
can help build your bone health. For general
health, at least half an hour of moderate to
vigorous exercise five times a week. Forty-five
minutes to an hour is even better.
Swimming and water exercise
Swimming is not a weight-bearing exercise, because
the buoyancy of the water counteracts the effects of
gravity.
Swimming will improve cardiovascular fitness and
muscle strength. People with severe osteoporosis or
kyphosis (hunching of the upper back) who are at
high risk of bone fractures may find that swimming
is their preferred activity.
Water exercise, such as aqua aerobics and
hydrotherapy, is also recommended. Consult with
doctor or health care professional.
Resistance Exercise for Osteoporosis
Resistance exercise increases bone density and reduces the
risk of fractures.
– Free weights or weight machines at home or in the
gym
– Resistance tubing that comes in a variety of strengths
– Water exercises - any movement done in the water
makes your muscles work harder.
Two or three times a week. Gradually adding weight or
repetitions and on different muscles - arms, chest,
shoulders, legs, stomach, and back. do not resistance
training on the same muscle group two days in a row. Give
each muscle group time to recover.
Flexibility Exercise for Osteoporosis
Important form of exercise for osteoporosis.
Having flexible joints helps prevent injury.
– Regular stretches
– T'ai chi
– Yoga
Precaution
Talk to your doctor before beginning any
exercise program
Weight-bearing exercise does not have to be
high impact.
Already have osteoporosis, be careful of
exercises that involve bending and twisting at
the waist
Muscle weakness
Refers to the inability to exert force with one's
skeletal muscles.
Muscle weakness is also a symptom used to
describe a number of different conditions,
including: lack of muscle strength, malaise,
dizziness or fatigue
Weakness often follows muscle atrophy and a
decrease in activity, such as after a long bout
of bed rest as a result of an illness.
There is also a gradual onset of muscle
weakness as a result of sarcopenia
Classification
True weakness (Objective weakness or
neuromuscular) describes a condition where the force
exerted by the muscles is less than would be expected,
for example muscular dystrophy. Patient suffers from
amyotrophic lateral sclerosis (ALS), motor neurons
are damaged and can no longer stimulate the muscles
to exert normal force.
Perceived weakness (Subjective weakness or nonneuromuscular) describes a condition where a person
feels more effort than normal is required to exert a
given amount of force but actual muscle strength is
normal, for example chronic fatigue syndrome (CSF)
Myasthenia Gravis
is true muscle weakness and a primary
symptom of a variety of skeletal muscle
diseases, including muscular dystrophy and
inflammatory myopathy. This disorder occurs
in neuromuscular junction
muscle strength is normal when resting, but
true weakness occurs after the muscle has been
subjected to exercise
Asthenia
is a medical term denoting symptoms of
physical weakness and loss of strength
A condition in which the body lacks or has lost
strength either as a whole or in any of its parts
occurs in many chronic wasting diseases, such
as anemia and cancer, in diseases of the
adrenal gland
also a side effect of some medications and
treatments, such as Ritonavir (a protease
inhibitor used in HIV treatment), vaccines
such as the HPV vaccine Gardasil and fentanyl
patches (an opioid used to treat pain).
is also commonly seen in patients suffering
from chronic fatigue syndrome, sleep disorders
or chronic disorders of the heart, lungs or
kidneys
Differentiating between psychogenic asthenia
and true asthenia with muscular weakness is
often difficult,
Differential diagnosis
Central muscle weakness manifests as an
overall, bodily or systemic, sense of energy
deprivation,
Peripheral weakness manifests as a local,
muscle-specific incapacity to do work.
Neural weakness can be both central and
peripheral
Lactic acid
build-up was the cause of muscle fatigue
can lower the sensitivity of contractile
apparatus to Ca2+ but also has the effect of
increasing cytoplasmic Ca2+ concentration
through an inhibition of the chemical pump
that actively transports calcium out of the cell
Lactic acid also has a negating effect on the
chloride ions in the muscles, reducing their
inhibition of contraction and leaving potassium
ions as the only restricting influence on muscle
contractions, though the effects of potassium
are much less than if there were no lactic acid
to remove the chloride ions
Pathophysiology
The sodium channels
spontaneously close, potassium
channels open, and positively
charged potassium ions exit the
fiber. Chloride channels also stay
open, and negatively charged
chloride ions enter the fiber. All
these actions cause the inside of
the fiber to become more
negative (“repolarized”). The
muscle fiber returns to its resting
state, calcium is pumped back
into the internal storage vesicles,
and the fiber is now ready to
accept another surge of positively
charged ions in response to
stimulation from a nerve fiber.
(When several muscle fibers are
at rest, a muscle can relax.)
Treatment
Appropriate periods of rest
Good hydration and nutrition and regular medical
care. (e.g. Treatment of muscle weakness caused by
electrolyte imbalance and/or dehydration)
Rehabilitation, physical therapy, occupational therapy
Regular program of exercise may be recommended
Corticosteroid medications may be prescribed to
reduce inflammation of the nervous system
Caused by bacterial infections generally involves
antibiotic medications
Caused by anemia may involve blood transfusions
Discussion
What is frailty syndrome, why it is so
important for aged people.
Why weight-bearing exercise has positive
effect on osteoporosis.
Can you compose a exercise prescription
for people with muscle weakness