sarcopenia与运动和营养干预

Sarcopenia与运动和营养干预整理ppt整理ppt整理ppt整理ppt整理ppt整理ppt整理ppt整理ppt(i)Whatissarcopenia?(ii)Whatparametersdefinesarcopenia?(iii)Whatvariablesreflecttheseparameters,andwhatmeasurementtoolsandcut-offpointscanbeused?(iv)Howdoessarcopeniarelatetocachexia,frailtyandsarcopenicobesity?(v)Whatistheroleofnutritioninpreventionandtreatmentofage-relatedsarcopenia?Whatamountsofmacronutrientsareneededforolderpeoplewithoratriskforsarcopenia,especiallyproteinandspecificaminoacids?Whatmicronutrients,e.g.vitaminD,playimportantrolesinprotectingandbuildingleanbodymass?整理ppt(vi)Whatistheroleofphysicalactivityinpreventionandtreatmentofsarcopeniainolderpeople?Whatexercisesarebestsuitedandmosteffectiveforolderpeople?Howcanolderpeoplebeenabledtotakemorehabitualphysicalactivity?Howcannutritionandexerciseregimensbecombinedforpreventionoftreatmentofsarcopenia?整理pptSarcopenia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。整理ppt整理pptMechanismsofsarcopenia

整理pptLossofStrength:BiologicCauses

Decreaseinnumberandsizeofmusclefibers.Numberofmotorunitsdeclineswithage.AbilityofCVsystemtodeliverrawmaterialstoworkingmusclesisreduced.Reductioninglycoproteins–moredifficultfortissuestoretainnormalfluidcontent.整理pptLossofStrength:BiologicCauses

Decreaseinefficiencyofmusclecells’selectivelypermeablemembrane.Concentrationofpotassiumisparticularlyreduced.Reducesmaximumforceofcontraction.Othernutritionrelatedeffects:VitaminCandZincClinicalimplications?

整理pptLossofStrength:FunctionalCausesDeclineinstrengthwithagelargelyduetodecreasedactivity.Mostaffectedareanti-gravitymuscles:quads,hipextensors,ankledorsiflexors,andtriceps.Functionalstrengthassessment:HandhelddynamometryBicepscurlsSit-to-standtest整理pptLossofStrength:PathologicCausesNumerousstrength-alteringdiseasesPolymyalgiarheumaticaSyndromeoccurringinolderindividualsCharacterizedbypain,weakness,andstiffnessinproximalmusclegroups(neck,back,pelvicandshouldergirdles)Alsofever,malaise,weightloss,veryrapidsedrateRespondsdramaticallytocorticosteroidtherapy整理pptSarcopeniacategoriesbycausePrimarysarcopeniaAge-relatedNoothercauseevidentexceptageingsarcopeniaSecondarysarcopeniaActivity-relatedsarcopeniaCanresultfrombedrest,sedentarylifestyle,deconditioningorzero-gravityconditionsDisease-relatedsarcopeniaAssociatedwithadvancedorganfailure(heart,lung,liver,kidney,brain),inflammatorydisease,malignancyorendocrinediseaseNutrition-relatedsarcopeniaResultsfrominadequatedietaryintakeofenergyand/orprotein,aswithmalabsorption,gastrointestinaldisordersoruseofmedicationsthatcauseanorexia整理ppt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)整理pptMeasurementsofmusclemass,strength,and

functioninresearchandpractice

VariableResearchClinicalpracticeMusclemassComputedtomography(CT)BIAMagneticresonanceimaging(MRI)DXADualenergyX-rayabsorptiometry(DXA)AnthropometryBioimpedanceanalysis(BIA)Totalorpartialbodypotassiumperfat-freesofttissueMusclestrengthHandgripstrengthHandgripstrengthKneeflexion/extensionPeakexpiratoryflowPhysicalperformanceShortPhysicalPerformanceSPPBBattery（SPPB)UsualgaitspeedUsualgaitspeedGet-up-and-gotestTimedget-up-and-gotestStairclimbpowertest整理pptSittoStandTestforLEStrength#repetitionsin30secondsNormsforelders:Women60-64,12-17reps90-94,4-11repsMen60-64,14-19reps90-94,7-12reps整理pptEWGSOP-suggestedalgorithmforsarcopeniacasefindinginolderindividuals

EWGSOP（EuropeanWorkingGrouponSarcopeniainOlderPeople)整理pptSuggestedprimaryandsecondaryoutcomedomainsforinterventiontrialsinsarcopenia

Primaryoutcomedomains•Physicalperformance•Musclestrength•MusclemassSecondaryoutcomedomains•Activitiesofdailyliving(ADL;basic,instrumental)•Qualityoflife(QOL)•Metabolicandbiochemicalmarkers•Markersofinflammation•Globalimpressionofchangebysubjectorphysician•Falls•Admissiontonursinghomeorhospital•Socialsupport•Mortality整理pptLowprotein+lowexercise=sarcopenia整理pptExerciseandSarcopenia

Strength:ClinicalImplicationsFunctionalstrength-training1RepetitionMaximum(1RM)Exerciseat60-80%of1RM1setof8-12reps*2-3timesperweekIncreaseweight10-15%perweekSuggestedtiming:2-3secondlift,4-6secondlower*Starckey,D,etal.:Effectofresistancetrainingvolumeonstrengthandmusclethickness.MedSciSportsExerc28(10):1311-20,1996.整理pptCalculating1RM

整理pptStrengtheningSeniors

Evidence-basedExaminationandExercisePrescriptionSectiononGeriatrics,APTAIntensityHigh60-80%1RM:8-12repstofatigueMosthealthyagingadultscando70-80%Low30-50%1RM:12-25repstofatigueBetterforthosewith:MI<6wksProgressiveneurodisorders(eg.MS)AcutemusculoskeletalconditionsandhealingtissuesVeryfrailordeconditionedindividuals整理pptStrengtheningSeniorsIntensitySlowmovement:“stoponadime”

Full,pain-freeROMGoodformandtechnique70-80%RPE“somewhathard”to“hard”

30-60%RPE“fairlylight”to“somewhathard”整理pptStrengtheningSeniorsDurationRepstofatigueSpeedincreasesFormdeterioratesFailstocompleteROMWatchfor:LookofconcentrationSlighttremorMildincreaseinrespiration整理pptStrengtheningSeniorsProgression30-60%1RM<25reps,sameresistance>25reps,increaseresistance10%70-80%1RM<12reps,sameresistance>12reps,increaseresistance5%Frequency2-3timesperweek整理ppt整理pptNutritionandSarcopeniaShort-TermCalorieRestrictionEnhancesSkeletalMuscleStemCellFunctionCRincreasesskeletalmusclestemcellfrequencyinyoungandagedmiceMusclestemcellsfromCR-treatedmiceshowincreasedabundanceofmitochondriaCRimprovesmuscleregenerationandenhancesstemcelltransplantefficiency整理ppt

Proteinprovidesaminoacidshaveastimulatoryeffectonmuscleproteinsynthesis

整理ppt整理ppt整理ppt整理ppt整理ppt整理ppt整理ppt整理ppt整理pptVitaminD整理pptAntioxidantNutrients整理pptLong-ChainPolyunsaturatedFattyAcids(LCPUFAs)整理ppt

FoodsandDietaryPatterns整理ppt整理ppt整理ppt整理ppt整理ppt整理ppt整理ppt整理ppt2临床表现

①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。②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。③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整理ppt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。

整理ppt整理ppt整理ppt整理ppt肌肉减少症(Sarcopenia)最早由Ev