Abstract
There is little understanding of the outcomes associated with active lifestyle interventions for sarcopenia among older persons. To determine the association of 6-month multidomain lifestyle interventions (physical exercise, nutritional enhancement, cognitive training, combined treatment, and standard care) with change in sarcopenia status and physical function among adults 65 years and older. Post hoc secondary analysis of a parallel-group randomized clinical trial conducted from September 1, 2012, to September 1, 2014, at community centers providing services to elderly individuals in Singapore. Participants included a subsample of 92 community-dwelling prefrail or frail older persons with sarcopenia aged 65 years and older. Data were analyzed from June 1, 2017, to January 1, 2018. The 5 intervention groups were a 6-month duration of physical exercise that included resistance and balance training, nutritional enhancement with a commercial oral nutrition supplement formula, cognitive training, a combination of the preceding 3 interventions, and standard care (control). Primary outcomes were changes in sarcopenia status and its components, appendicular skeletal muscle index (ASMI), knee extension strength (KES), and gait speed (GS) at 3 months and 6 months following the intervention. Sarcopenia was defined as the presence of both low ASMI and low KES and/or GS. In 92 participants with sarcopenia, the mean (SD) age was 70.0 (4.7) years and 59 (64.1%) were female. Seventy-eight participants received active interventions and 14 received standard care. Of 92 total participants, the number who remained sarcopenic was reduced to 48 (of 73) after 3 months and 51 (of 75) after 6 months of intervention, indicating that 25 of 92 participants (27.2%) experienced sarcopenia reduction at 3 months and 24 of 92 (26.1%) had sarcopenia reduction at 6 months. Low KES was present in 88 of 92 patients (95.6%), and low GS in 30 of 92 patients (32.6%) at baseline. Among the components of sarcopenia, GS had the greatest change associated with active interventions, with 22 of 30 participants (73.3%) free of low GS at 6 months; in comparison, 17 of 88 participants (19.3%) were free of low KES at 6 months and 7 of 92 participants (7.6%) were free of low ASMI at 6 months. Men experienced greater reduction in sarcopenia than women (χ2 = 5.925; P = .02), as did those with younger age (t = -2.078; P = .04) or higher ASMI (mean [SD] ASMI, 5.74 [0.77] vs 5.14 [0.77] kg/m2; P = .002). Participants in the active intervention group experienced statistically significant decreases in sarcopenia score and its components at 3 months and 6 months from baseline (F = 14.138; P < .001), but the intervention was not associated with significant differences in ASMI, KES, and GS vs standard care. This study suggests that older persons with sarcopenia are responsive to the effects of multidomain lifestyle interventions. Sarcopenia reduction was most pronounced through improved gait speed, and occurred more among those who were male, were younger, or had greater muscle mass.
Highlights
Sarcopenia is a hallmark of the aging process involving the accelerated loss of skeletal muscle mass, strength, and function.[1]
Among the components of sarcopenia, gait speed (GS) had the greatest change associated with active interventions, with 22 of 30 participants (73.3%) free of low GS at 6 months; in comparison, 17 of 88 participants (19.3%) were free of low knee extension strength (KES) at 6 months and 7 of 92 participants (7.6%) were free of low appendicular skeletal muscle index (ASMI) at 6 months
Sarcopenia reversal was more likely to happen in men, younger individuals, and those with higher baseline lean muscle mass. Meaning These findings suggest that multidomain lifestyle interventions may be effective in reversing sarcopenia and improving muscle mass and function in community-dwelling at-risk frail older adults
Summary
Sarcopenia is a hallmark of the aging process involving the accelerated loss of skeletal muscle mass, strength, and function.[1]. There is a current consensus that sarcopenia is potentially reversible.[6] The average nutritional consumption of elderly persons with sarcopenia falls below the Recommended Dietary Allowances for micronutrients.[7] Studies in humans[8,9,10] suggest that physical inactivity and anabolic resistance (a blunted synthetic response to protein and exercise) are primary drivers of muscle mass loss in the aging process. Cognitive training is found to maintain and improve GS and balance in the elderly,[20,21] its effects on sarcopenia have not been reported yet These studies were graded as very low–quality to low-quality trials conducted in heterogeneous populations with relatively short intervention durations and yielded mixed results.[14] There is still little understanding of the associations of active lifestyle interventions among elderly individuals with reducing sarcopenia and its component muscle mass and function
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