Abstract
Cardiac cachexia is a condition associated with heart failure, particularly in the elderly, and is characterized by loss of muscle mass with or without the loss of fat mass. Approximately 15% of elderly heart failure patients will eventually develop cardiac cachexia; such a diagnosis is closely associated with high morbidity and increased mortality. While the mechanism(s) involved in the progression of cardiac cachexia is incompletely established, certain factors appear to be contributory. Dietary deficiencies, impaired bowel perfusion, and metabolic dysfunction all contribute to reduced muscle mass, increased muscle wasting, increased protein degradation, and reduced protein synthesis. Thus slowing or preventing the progression of cardiac cachexia relies heavily on dietary and exercise-based interventions in addition to standard heart failure treatments and medications. The aim of the present study was to test the feasibility of an at-home exercise and nutrition intervention program in a population of elderly with heart failure, in an effort to determine whether dietary protein supplementation and increased physical activity may slow the progression, or prevent the onset, of cardiac cachexia. Frail elderly patients over the age of 55 with symptoms of heart failure from UAMS were enrolled in one of two groups, intervention or control. To assess the effect of protein supplementation and exercise on the development of cardiac cachexia, data on various measures of muscle quality, cardiovascular health, mental status, and quality of life were collected and analyzed from the two groups at the beginning and end of the study period. More than 50% of those who were initially enrolled actually completed the 6-month study. While both groups showed some improvement in their study measures, the protein and exercise group showed a greater tendency to improve than the control group by the end of the six months. These findings suggest that with a larger cohort, this intervention may show significant positive effects for elderly patients who are at risk of developing cardiac cachexia.
Highlights
Age-associated changes occur at different rates in various systems of the body over decades with an ultimate reduction of physical strength and function [1,2,3,4]
The aim of the present study was to test the feasibility of an at-home exercise and nutrition intervention program in a population of elderly with heart failure, in an effort to determine whether dietary protein supplementation and increased physical activity may slow the progression, or prevent the onset, of cardiac cachexia
A common aging change that occurs in the skeletal muscles is termed sarcopenia and is characterized by loss of skeletal muscle mass that occurs at a rate of approximately 1% per year after age forty and can be exacerbated by sedentary behavior, poor nutritional intake, and pathological conditions [1, 5,6,7,8,9,10]
Summary
Age-associated changes occur at different rates in various systems of the body over decades with an ultimate reduction of physical strength and function [1,2,3,4]. Slowing or preventing the progression of cardiac cachexia likely relies heavily on dietary and exercise-based interventions in addition to HF therapies and medications. Such interventions typically include an increase in the total number of calories consumed each day, but a pointed effort to increase the protein intake of the individual to 1.5-2.2 g/kg body weight per day [7, 19,20,21,22]. Increased physical activity, both aerobic and resistance exercise, has been demonstrated to reduce sarcopenia, improve muscle strength and cardiovascular function and reduce metabolic dysfunction [20, 23, 24]
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