Abstract
The clinical, pathological and biological characteristics of frailty and sarcopenia are becoming better understood and defined, including the role of systemic inflammation. It is increasingly apparent that in older adults there is a tendency for the innate immune network to shift toward a pro-inflammatory setting, often due to the presence of chronic inflammatory diseases but also associated with age alone in some individuals. Furthermore, acute inflammation tends to resolve more slowly and less completely in many elderly people. Inflammation contributes to the pathogenesis of sarcopenia and other components of the frailty syndrome. Blood levels of inflammatory cytokines and acute phase proteins, are reduced by exercise, and there is a growing body of epidemiological, observational and intervention research that indicates that regular moderate exercise improves strength, function, morbidity and mortality in middle-aged and elderly adults. There is also an increasing awareness of the potential role of drugs to ameliorate inflammation in the context of frail old age, which might be particularly useful for people who are unable to take part in exercise programs, or as adjunctive treatment for those who can. Drugs that shift the innate immune biochemical network toward an anti-inflammatory setting, such as methyl-xanthines and 4-amino quinolones, could be of value. For example, theophylline has been shown to induce a 20 percent fall in pro-inflammatory tumor necrosis factor (TNF) and 180 percent rise in anti-inflammatory interleukin-10 production by peripheral blood monocytes, and a fall of 45 percent in interferon-gamma (IF-gamma) release. Such properties could be of therapeutic benefit, particularly to re-establish a less inflamed baseline after acute episodes such as sepsis and trauma.
Highlights
Geriatricians and other clinicians have become increasingly aware of the need to gain a better understanding of the frailty syndrome, a clinical state that can cause difficulties for elderly patients across the bio-psycho-social spectrum
The autocrine and endocrine effects of IL-6 on myocytes appear to depend on the pattern and context of IL-6 release so that the acute peaks that occur with vigorous exercise appear to have a role in building muscle bulk, contractile strength and endurance whereas chronically elevated baseline IL-6 levels are thought to play a part in the degenerative changes that lead to myocyte apoptosis and sarcopenia [66,73]
The available data suggest that older people who are able to perform regular moderate exercise as part of a lifestyle habit can reduce their risk of a number of adverse health outcomes, including some of the components of frailty and sarcopenia
Summary
Geriatricians and other clinicians have become increasingly aware of the need to gain a better understanding of the frailty syndrome, a clinical state that can cause difficulties for elderly patients across the bio-psycho-social spectrum. The focus of this paper, set within the framework of old age, will be the key role of systemic inflammation in the pathogenesis of several aspects of frailty including sarcopenia and cachexia. The preventive and therapeutic utility of exercise in this context will be considered. There is an extensive literature dealing with these, and closely related, topics so this review will be an overview of key insights and evidence over the last 25 years. With respect to the future, the possibility of preventing, ameliorating or reversing aspects of frailty by intervening with pharmacological agents will be considered.
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have