سارکوپنی

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Sarcopenia and aging By reihaneh delbari 

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Sarcopenia: From the second to the eighth decade of life, total lean body mass (LBM) declines by about 18% in men and by 27% in women. Sarcopeniais the degenerative loss of skeletal muscle mass (0.5-1% loss per year after the age of 50), quality, and strength associated with aging. Sarcopenia is a component of the frailty syndrome. ۱ In 2010, the European Working Group on Sarcopenia (EWGSOP) developed a working definition “sarcopenia is a syndrome | muscle characterized by progressive and generalized loss of skele’ scle of mass and strength with a risk of adverse ov ‏تمي‎ Meaty disability, poor quality of life and death.” NE rae ۳ [۳ ‏ی‎ Bal gy tae we 

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arcopenic obesity SO is a ratio of ASM (appendicular skeletal muscle) to body height squared (ASM/ht2) less than 2 standard deviations below the sex- specific mean of a younger reference group and as a percentage of body fat greater a ntramuscular fat accumulation: Fat infiltration is believed to sustain sarcopenia through a macrophage infiltration mediated-release of pro-inflammatory cytokines (such as TNF-a, IL-6, IL-1) and adipokines (leptin, adiponectin and resistin) from adipocytes. 

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egional distribution of sarcopenia For both men and women, the decrease in LBM is greater in the lower limbs (about 15%) than in the upper limbs (about 10%). »Constant use of the lower limbs for locomotion » A greater loss of motor units in the legs than in the arms iscle fibre size, number and composition The decrease in muscle mass that gives rise to sarcopenia involves both a decrease in muscle fibre size (atrophy) and number (hypoplasia). There is firm evidence that with ageing type I! fibres are more vulnerable to atrophy than type | fibres. 

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1 resting energy expenditure 1 nsutinsenst ۷ Sarcopenia J muscle mass and strength T risk of physical disability 1 of falls Biochemical Pathways of Sarcopenia and Their sk of odulation by Physical exercise: A Narrative B riskot death 

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Sedentary ifes T Pistein degradation Inactivity Protein imbalance is P Sarcopenia ratory factors | Dietary intake T Protein synthesis Mitochondrial dysfunction J Anabolic hormones ‏اس سس‎ 

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Endocrine corticosteroids, GH, IGF-1 abnormal thyroid function insulin resistance SARCOPENIA ع + Age-related (Primary) sex hormones Neuro-degenerative apoptosis diseases mitochondrial dysfunction motor neuron loss Inadequate nutrition / Malabsorption Disuse immobility physical inactivity zero gravity Cachexia “Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People", by Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al., 2010, Age 

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Primary sarcopenia Age-related No other cause evident except ageing sarcopenia fecondary sarcopenia Activity- Can result from bed rest, sedentary lifestyle, deconditioning or zero-gravity related conditions sarcopenia Disease- Associated with advanced organ failure (heart, lung, liver, kidney, brain), related inflammatory disease, malignancy or endocrine disease sarcopenia Nutrition- _ Results from inadequate dietary intake of energy and/or protein, as with related malabsorption, gastrointestinal disorders or use of medications that cause sarcopenia. anorexia 

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Stage Muscle mass Musclestrength Performance Presarcopenia Sarcopenia 1 1 01 Severe sarcopenia 

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FN [Mig kg< 1975 (M) <15A2(F) Mj BM 0719100508 <26ig(M)<16kg(F) gM <1 (0) <056(F) Sarcopenia with Limited mobility SMI igi? < 681 (M) <518(F) <1ms6MWT 400m So kg 7200 >58 <Imjs BSPENSIG كانس الا 15 م EWGSOP SMI gin? <726(M) 534 ماديا 5 Table teria and cuo used Muscle mass DXA ی ‎Handgip‏ Walking speed Tinedget-upantgotet > 10s BGSOP: European Working Group on Sarcopenia in Oder People (Cru Jeno et al, 2010); ESPEN SIC: Special Interest Group “acheia-anoreia in chronic wasting iseases" (Muscat etal, 2010 NGS: ltermatinal Working Group on Scopes Fielding eta, 2011); Sacopenia wit ited moti: Society fr Sarcopeia acer and Wasting Disorders (Morey tal, 2011} FAH Sarcopenia project Student etl 2074); LM: an mas; App ppendiua, SME skeletal musce mass index; BME: boy mass index WT: 6-minue walking test; M: male: femal enia. Anne Tournadre, Gaelle Vial, Frédéric Capel, Martin Soubrier, Yves Boirie - Review (2018) 

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(> 65 years)+ Measure gait speed * Comorbidity and individual circumstances that may explain each finding must be considered +This algorithm can also be applied to younger individuals at risk | Normal 

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Table 1 ‏عمط‎ relevant outcomes, namely muscle mass, strength, physical 3 performance, and sarcopenia, Outcome Muscle Mass Muscle Strength Physical Performance Sarcopenia sone 0 Short Physical Performance Seay ey Battery (SPPB) Combined outeomes of absomptiometry (DXA) Handgrip strength Acceptable Gait walking speed muscle mass, muscle measures ‏سور ی‎ oven See Timed getup-and-go test strength or physical omputed tomography (CT) Musclequaliy index 1848 ‏مه‎ ‎۳ ‏تسس‎ Stair climb power test imaging (MRI) * Includes mid-arm circumference and triceps skinfold measures to determine mean arm muscle area (MAMA). Diet Quality and Sarcopenia in Older Adults: A Systematic Review. llse Bloom, Calum Shand, Cyrus Cooper, Sian Robinson and Janis Baird. (2018) 

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obesity reviews ets 10 1 ‏جمد من‎ Review Changes in physical activity over the lifespan: impact on body composition and sarcopenic obesity Received 7 Sapiomber 2018: accopted 11 K. R. Westerterp ® ‏ما‎ ۳۱۷5۱621 2011۷10۷ ۵00 6: When children start to move independently, the PAL value is about 1.4. PAL increases with increasing age to reach a plateau value of 1.7 to 1.8 at reproductive age. After the age of 50 years, PAL generally decreases to reach a minimum below 1.4 at age of 80 years and older. The plateau value for PAL at reproductive age tends to be slightly higher for men than for women. Inter-individual variation in PAL is high at all ages. The theoretical minimum value is 1.12 for a subject without any body moment, only resting and eating to balance resting enerayv exnenditure. The maximiim value ic 2.00 to 2.50 asc ohserved 

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0 25 50 7 100 Age (y) Figure 1 General model for physical activity lavel, doubly labelled water assessed average dally energy expenditure divided by resting energy ex- penditure, in relation to age for women (continuous line) and men (broken line), derived by combining data from references (17) and (18). 

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Body composition and age: In girls, FMI increases, and in boys, FMI decreases. The overall result of the change in FFM and FM during adolescence is a difference in body fat of about 10% of body weight between women and men at adult age. Body fat (%) 6 20 40 ۰ Age (y) Figure 2 General made! for body composition in rolation to age for worren (continuous fine) and men (broken line), derived by combining dala from references (22) and (23), 

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Sarcopenic obesity Prevention of sarcopenic obesity requires a physically active lifestyle throughout the lifespan, in combination with restriction of energy intake to prevent excess body fat, limiting body movement. 

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Estimated linear changes in energy intake (kcal/day) in 922 men and 879 women over a 12-year follow-up period, according to (4-year) age group at baseline Does nutrition play a role in the nt of prevention and manage! 1 Women 

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7 EVIER Original study Effects of Resistance Training on Functional Strength and Muscle Mass in 70-Year-Old Individuals With Pre-sarcopenia: A Randomized Controlled Trial anna Vikberg, Niklas SOrlén®, Lisa Brandén®, Jonas Johansson PhD. a Nordstrém MD, PhD", Andreas Hult PhD*, Peter Nordstrom MD. PhD Method: Participants were randomized to either 10 weeks of a physical training regimen including optional nutritional supplementation (n = 36) or to a contro! group (n = 34). Persons in the intervention group were assigned to participate in a 10-week instructor-led progressive RT program consisting of 3 sessions (w45 minutes each) per week with groups of 12 participants. joderate to high RT intensity was applied using the Borg CR-10 scale, with participants’ perceived exertion scoring 6 to 7 of a maximum of 10. During the sessions, 8 exercises were performed with the aim of engaging muscle groups in the whole body, with a focus on strengthening of the lower-extremity muscles using functional exercises that are relevant for activities of daily living. Also, suspension bands were used as support for a majority of the exercises. 

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During the first week of training, no weight was used, and exercises were performed in 2 sets of 12 repetitions each, followed by 3 sets of 10 repetitions each in weeks 2 to 4. In weeks 5 to 7, participants performed 4 sets of 10 repetitions each. In weeks 8 to 10, the focus was on muscle power training using the same AXFMAFenal supplement (taken once a day for 10 weeks) was also offered to participants in the intervention group, but it was not a mandatory component of the program. The 250-mL liquid supplement was milk based with added milk protein, supplying 175 kcal in the form of 19 g carbohydrates, 21 g protein, and 1.5 g fat (week 1-7 of the intervention) or 10 g carbohydrates, 30 g protein, and 1.5 g fat (week 8- 10 of the intervention). 

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۱0۵۱۵۸۸۸۸۱3۱ 5 تمستا مس مصعم ‎Control (n =34)‏ ‎Difference Diference‏ 005 = 127 030.2224 0105 (006 + 151 078 £187 055 +390 02 +090 0007 +135 0015 2 oot +065 0005 £025 0 Intervention (a= 31) 10 wk 309 = 067 825 £212 38205 117.209 357 + 153 32017 200 + 464 419 +794 453.2131 136 28 640 = 089 Baseline 329207 281 + 943 38405 كه 1144 194 8905 955 + 37 499 وود 408760 122 4302 1325281 Table2 Changes inthe Outcomes During the 10-Week Intervention Period ۶ 8 48 37 82 3 4 0 0 n 3 58 erences 10 wk 3854 164 105 400 38405 TEL 9104314 305 +106 2344791 4194863 4374 146 135430 6234086 Witia-Group bi Contol (a =34) Baseline SPP walks 381 £098 ‏ماو‎ stands 106 = 408 Balance, 0-4 37207 Totalsore 12 TD 17 TGs 9992234 Handgrip. 300+ 114 DXA measurement Total at mass kg 781+ 807 Tota ean mass, ig 418 +864 Armlean mass.ig 456144 Log lean mass,lg 136 +307 AM 624 + 085 ALM appendcularlean mass index Values are presented as means + SDs. 

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‘intervention group control group Handgrip PPB Walking Sitto-stand TUG ‘Men =] Change from baseline (%) PPB Walking Sit-to-stand TUG Handgrip Women Fe 2. chang tam se |] Sein he ene gop acm pup fr men nd women spat, Mens andar nr ft ma re intervention our Bcontol group the intereention group and contol group for men and women separately. Means and standard eror ofthe mean ate eae Te ft Total fat A ‏اقا اج‎ ‘TotalleanLeglean Armican ALM Men Total fat ‘Women, eg ١ Leglean Armlean ALM resend. change from baseline (6) Fig. 3 Changs fom baseline presented. (ALML appendicular| 

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Results: the intervention group decreased 0.9+0.6 seconds in chair sit- stand time compared to controls (P =.01). Furthermore, the intervention resulted in significantly greater improvements for the training group than control group in all measures of body composition (P <.01 for all). For example, lean body mass increased by a mean of 1147+ 282 g (P < .001), and total fat mass decreased by a mean of 553 + 225 g (P= .003), favoring the intervention group. Conclusion: The main finding of this intervention study is that a functional resistance training program was effective in maintaining functional strength and increasing muscle mass in older adults with pre- sarcopenia. 

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Effects of Aerobic and Resistance Exercise on Metabolic Syndrome, Sarcopenic Obesity, and Circulating Biomarkers in Overweight or Obese Survivors of Breast Cancer: A Randomized Controlled Trial. Dieli-Conwright. C.M.: Coumeya. K.S.: Demark-Walmefiied. W.; Sami, N.: Lee, K.: Buchanan, T.A.: Spicer, D.V.: Tripathy, D.: Bernstein, L.: Mortimer. J.E Vol. 36 Nr. 9 Pagina: 875 - 883 Fecha de publicaciéu: 20/03/2018 Methods: Eligible survivors of breast cancer (N = 100) were randomly assigned to exercise (n = 50) or usual care (n = 50). The exercise group participated in supervised moderate-to-vigorous-65% to 85% of heart rate maximum-aerobic and resistance exercise three times per week for 16 weeks. Metabolic syndrome z-score (primary outcome), sarcopenic obesity, and serum biomarkers were measured at baseline, postintervention (4 months), and 3-month follow-up (exercise only). 

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Results: Participants were age 53 + 10.4 years, 46% were obese, and 74% were ethnic minorities. Postintervention metabolic syndrome z- score was significantly improved in exercise versus usual care (between-group difference, -4.4; 95% Cl, -5.9 to -2.7; P < .001). Sarcopenic obesity (appendicular skeletal mass index, P = .001; body mass index, P= .001) and circulating biomarkers, including insulin (P = .002), IGF-1 (P = .001), leptin (P = .001), and adiponectin (P = .001), were significantly improved postinterven-tion compared with usual care. At 3-month follow-up, Conclusion Combined resistance and aerobic exercise effectively attenuated metabolic syndrome, sarcopenic obesity, and relevant biomarkers in an ethnically diverse sample of sedentary, overweight, or obese survivors of breast cancer. 

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ScienceDirect ‏مط گس‎ en etra cites Review Article Effectiveness of nutritional and exercise Qe interventions to improve body composition and muscle strength or function in sarcopenic obese older adults: A systematic review Christos Theodorakopoules“, Jacklyn Jones *"", Elaine Bannerman”, Carolyn A. Greig® Out of 109 full text articles identified, only two RCTs (61 participants) met the inclusion criteria. One study was a nutritional intervention adding 15 g protein-day—1 (via cheese consumption) to the participants’ habitual diet. The second study was a high-speed circuit resistance training intervention. Main inclusion criteria comprised sarcopenia as defined by the European Working Group on Sarcopenia in Older People (EWGSOP) and obesity defined as % body fat =40% 

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Diabetes Melitus Metabolic Syndroma Cardiovascular Disease t Impaired Glucose Metabolism Insulin Resistance Inflammation & ae Intormuscular Adipose Tissue أ و ie Physical | 7 ‏وت‎ Inactivity ae Physical Disability Fig, 1 - Relationship between sarcopenia and obesity and associated risks as well as management strategies. Notes: Solid arrow: direct and positive association; Dashed line management strategy attenuating/reversing the condition: 

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Study design: The aim of study A was to assess whether the addition of a protein rich food to the habitual diet could increase TASM (Total appendicular skeletal muscle) and strength in older individuals with sarcopenia. The study was a 3-month RCT with a control (habitual diet; HD) and an intervention group (habitual diet +210 g ricotta cheese per day; RCH + HD). The cheese provided 15.7 g extra protein (including 8.6 g of essential amino acids), 10.4 g carbohydrate, 18.4 g fat and a total of 267 kcal per day. Cheese was divided into three 70 g portions and participants were instructed to consume each portion along with their usual breakfast, lunch and dinner. 

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Study design: Study B was a 15-week single blind RCT, which aimed to assess the effectiveness of a novel exercise regime based on a high speed circuit (HSC) resistance training program (intervention) on body composition, muscular performance and IADL compared with a conventional strength hypertrophy (SH) regime (control group) in community- dwellers with SO. Both groups performed exercises at 11 pneumatic gym machines twice per week. The SH protocol involved three sets of 10-12 repetitions at 70% of 1RM with a 1-2 min recovery break between sets. The HSC group performed 10-12 repetitions at the same 11 exercises, but in a circuit pattern (i.e. moving from one exercise to the other) with no break in between exercises, unless one full circuit was complete. Three full circuits were performed in total. 

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‘Teble 2-Summary ofthe inlued studies ین مها ماهر هلا وه ده مره چم هی .رنه ‎ody compason Yeasue‏ سس ما 0 و تس سود ‎Dei‏ ‏0 ۳ ی ‎Due ae‏ احم مه ل م6۸ 167 .هه :ةصنملا سمط اط رو ‎independ, aoe ated ep) 0‏ یه لوا سار ‎bese 00-1‏ اس هه و ‎‘onal one‏ ۳ شد ا ‎based on SF‏ مه ‎soos‏ ‏كم قل مار هال ‎(ScVindepeden ing No‏ 754 تسایر و اه امسا سرد ‎ey. roving‏ ۳ che baad on say ‏ام تعاس‎ —7(82fotepeniesrlvng | ‏مه و ماه وم منود‎ ۳ sonmuniy duces fom Sod maining 1 exc, Sees ‏وه‎ ‏وهی اه‎ ar ‏ما مره‎ on Sh) 0-2 ee pratt 70% ‏انق‎ Don-t ered td ‏هو وه مه ایا مس مب‎ iswecks ‘ar and se Legpres 18, chet es ‏وما ماقا‎ pres wey, Chet ess ewer, Inurenioa 716(7a)independenrving | ‏مه هجو‎ | No ‏مد باه ماس‎ 1a S08 sorumuniy ducers for Sout taiing 1 emcees 3 Vag IM, eg Mar ‏اله وت‎ ep per 0 ower", Chet erie tad tat Post sty chet ‎ca over"‏ ار مومت ‎ ‎Ter ao ipiicaat change pie nese, plan ease" O08" <000, + pinay beter tan the and pup, 1, pent dy BML ody ide DHA bce ‏ربعم طاو وقد وس‎ ft a Gnd lean ae RCT, andre coed i ‏هر‎ aim SM et rsdn 5, shor phe perfomance ater tt TASY tol apenas masse ‎ ‎ ‎ 

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The lack of significant changes in lean mass or muscle mass after exercise training in adults with sarcopenia, may be accounted for by protocol-specific differences such as: duration, type, intensity, volume and frequency of exercise, as well as the availability of adequate nutrients (protein/amino acids), which are needed to elicit an anabolic response and consequently muscle hypertrophy. 

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Effects of elastic resistance exercise on body composition and physical capacity in older women with sarcopenic obesity A CONSORT-compliant prospective randomized controlled trial Chun-De Liao, PT, MSc», Jau-Yih Tsauo, PT, PhD®, Li-Fong Lin, PT, PhD”, Shih-Wei Huang, MD°, Jan-Wen Ku, MD®, Lin-Chuan Chou, MD®, Tsan-Hon Liou, MD, PhD®“=* Racaived: 19 December 2016 / Received in final for 28 April 2017 / Accepted: 12 May 2017 Methods: A total of 46 women aged 67.3 (5.2) years were randomly assigned to an experimental group (EG) and control group (CG). The EG underwent elastic RET for 12 weeks, and the CG received no RET intervention. 

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With in 12 weeks of RET intervention, all patients in the EG attended 3 training sessions weekly and each exercise session involved a general warm-up of 10 minutes, followed by resistance training exercises (35-40minutes), and finally a cool-down routine. The 15- point Borg scale was used to rate the patients’ perceived exertion ranging from 6 (“no exertion at all”) to 20 (“maximal exertion”) during the training sessions; the movements were aimed at strengthening the main muscle groups in the trunk and the upper and lower extremities that are crucial. for physical mobilityFor each exercise movement, 3 sets involving 10 repetitions of gentle concentric and eccentric contractions through the full range of motion were slowly performed with the initial use of a yellow elastic band. the band colors, namely yellow, red, green, blue, black, and silver, denote the degree of elasticity and indicate the corresponding 

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Adjusted mean change in body composition and physical capacity outcomes at posttest from baseline. Baseline Posts! Adjusted changet Ditlerence of change Measures Experimental Control ‘Experimental —_—Contol_—_—Experimental_—_—_—<Conl Experimental-contol Baty FM, kg 6582430 97002408 © 36862435 © 316562368 | ‏لدت‎ 040 UM, ig 1042145 11084160" — 1108166 10571688 | 0201 0180120 0790456114“ 1۷9 392594 20174588 2570253 296060 |074024 O10] 1.25 (1.98, -0.51 BF 41652402 43404523 4084377 4406497 ‏تلديم[‎ 0ه02028(‎ 1.83 260, -1.085) Psi ‏چیه‎ 9 ‏:که‎ ۱ ‏ما و‎ 1512028 1164028 1532023 1112020 | Gtdz004 © 0.12004) 021 008, 0.30" 16s ‏فاعم‎ 9514246 7002133 9454255 1.394024 0034028] -142 216, 088" ‏کت‎ 24495 11382304 17602369 11622307 | 353068 102078] 456.235, 676)"" ‏هه ما‎ ‏قوقعقات ... وا ,ماس‎ 2048574 24492404 2064. 801 21620683 0034060) 2.19 (025, 4.19) 13801547 15262482 21172724 135923705 | 7862093 «= 179100) 9.65 GB, 1229) 2.83 1.2, 4.06) 1.94 (1.39, 250)"" 072051 09019 iets 046 1552018 12994308 11684347 146829" = 11014.875 2474098 2954081 4072120" 249068" a cot ‏اناج‎ f.=2i), Data ae presented as mesa SD. “P05, “P-<.01, “"P.O01. BP =percentge boty fa, FFM ta-tee mass, GS= gat speed, LE—loner ‘toni Le ean mas, S.S= nga tana, TOR=tied hat TEM tres, TUG=timed ‏تنه وس ها ماه و‎ * dea reseed mean canoes wth sad ar wth vale he base, ot’ ae, ad onary soe 25 cores dues nica a sear tierce compare wth tase, P<. 05 

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Physical capacity TUG TR 014 82 2 oaz" 026 ~04s"" 012 =a58""" nel sto, TOR tina i ib, TU melt Contr Postest 7 ۶ 9 429) 52 1 12(67.4) 74 >00 205) 4 0 Relationship between changes in body composition and physical outcomes at posttest. Muscle quality Body composition measures* 3 ‏ع‎ es FAM ost" 0.10 ‏الا‎ 0 0.26 TAL ~038" 035" a 081" 030" 58 > 05 "P<, "P< OO. Hp bo, oma ‏اللا تكله توما ها ,امعو سح‎ en mas as, TUG=tined up-to test, UE= igo etey AL muscle mas als wer Vase opie cheng fu bie, ۳7 Effects of elastic resistance exercise training on muscle mass and mobiity dtficulty. Experimental Measures Baseline Postest Baseline Low muscle mass 15 600) 200 14 (667 Physcal duty! 16 640) 200 13 0 )405 ).66 14 )160( 4 تسس ار ‎teeta of he mean‏ یه ۱0 رنه هط صاصق ۱۵ 13 ۶ هه سا "ra ty sng be Wien sped ste othe cans om basing ws yar chaque et at te dict tel nd ono gs Lon usc mass ves dete using he cu pat ote lve 20% of te dst rests fr apendcdar mas ‏هلها‎ >-2024/77 |Pyscaletcut was ied as 3 ormare tutes anang te scales tat che cub pon, tad gp 143k. gat soe <1 Ose, ted ago et >see, ta hase <2 reais, single soe <1) 

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Biochemical Pathways of Sarcopenia and Their Modulation by Physical Exercise: A Narrative Review Mohammad Mosaferi Ziaaldini', Emanuele Marzetti®*, Anna Picca* and Zsolt Murlasits? ® trontiers in Medicine 

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1 ۱۹/2 \ mTOR ‏6ه‎ ‎۱۷۵ ‏کر‎ ‎1" ۷ 0 Mitochondrial ‏و سر‎ dynamics & biogenesis, aaa see | 4 Protein synthesis Protein degradation est FIGURE 2 | ۴۳99 of agg and physical exerte on slgnalng pata ated in sarcoperia, Abbroviatione:Cyt-C: eyochrome O; ERK: axracellrcgna ‏موه‎ ‎nase; FoxO. Foread box ; OF-t: Insli-Lke Growth Factor 1: MAPKSS: Mitoger-Actiated Frctan Kinases; mTOR: marrmaian target of rapamycin; MUP: ued FING-fnge rot NFB: clear factor x8 NAF: nuclear respaloy factor, PGC- ta prolsome prollerator-actvated receptor ycoactvator-1a; ROS: reactive oxygen species: SFT: stun: SAD: smal mother against decapentaplegic TFAM: mtochondil resoration factor &s TNF: turr necrosis factor apa, 

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TABLE 1 | Ameicen Cologect Spats Mice Amaicen Heat assole ‏هه م10 تمه‎ de acs. Frequency Intensity Duration Tye chic —_Noteee-iensyetites, aooumiee Onascdecf0-10‘o RPE, Moccia acts, Ary modal that doesnctimpose ‏ممه‎ 288109105000238 —«5-Bformoderecrtersiy, accumuezatast 0 miniday excess othopedi tess, wakrgis benef infdqjnbouts fat east and 7-B for vigorous inbouts ofatkast 10min the mast oommon type of 20017 ‏قو‎ ‘Omi eachto fof 60-300 in intensity ‏عله وقد‎ 20 miniday of exasendlatona gle errs week at ast 20-80 mindy or move coninuous acy forvorous- be advartageous or Tose win Imig ‏ها صقان دهع نورد‎ itersty ates ] or weg beatg city TAS mine ‎Alt 2 dase Betueenmedats 6-8) may vay deperdsonnurber Progessie mht ering pagan‏ مده ‏انتمهم نا 33 ‏0 مه 10لا موه اه رها ‎gations each, str cnn,‏ 019-11 ‎an ote stengheing acs hal se‏ 7 | 70000905 ‎APE Boy ‏دفوم ولثم‎ in ‎ ‎ ‎ 

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© 2017, Copyright the Authors Journal compilation © 2017, The American Geriatries Society Effects of Different Types of Exercise on Body Composition, scle Strength, and IGF-1 in the Elderly with Sarcopenic Hung-Ting Chen, PhD.* Yu-Chun Chung, PhD.! Yu-Jen Chen, MD. PbD,! Sung-Yen Ho, PLD and Huey-June Wu, PhD* PARTICIPANTS: Sixty men and women aged 65-75 with sarcopenic obesity. These participants were equally divided into the RT, AT, combination training (CT), and control (CON) groups. Sarcopenia is defined as appendicular skeletal muscle mass (ASM) (kg)/Weight (kg)*100%. The determining threshold value is <32.5% for men and <25.7% for women. Obesity indicators are body mass index (BMI) = 25 kg/m2, and visceral fat area (VFA) = 100 cm2. 

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Exercise Training Program: The RT group participants used weight-training equipment at 60-70% of one repetition maximum. They were trained two times a week for 8 weeks. Mainly the large systemic muscle groups were targeted, and 10 exercises were incorporated in the training design. Progressive resistance load training was used, in which the difficulty of the exercise was adjusted every 2 weeks in ascending order from simple to difficult. The participants performed three sets of 8-12 repetitions with a 2-3 minute rest between sets. The total training time was 60 minutes with 186081۲ 02۷926082264 tPainiAgwessiynintense AT in two 60-minute sessions per week for a total of 8 weeks. The session consisted of 5-10 minutes of dynamic stretching and warm up and 40-45 minutes of the actual training. The class comprised a combination of dance steps. In addition, 10 minutes of closing and relaxation exercises were included. 

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The CT group engaged in identical, but separate, RT and AT. For a total of 8 weeks, they performed each training mode once a week with the AT following 48 hours after the RT. The CON group simply maintained their day-to-day lifestyles and dietary habits and was prohibited from engaging in any exercises. 

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Table 2. Influence of Different Exercise Modes on the Body Composition, Muscle Strength Performance and Blood IGF-1 Concentration of Older Adults with Sar- copenic Obesity Baseline Week 8 Week 12 Weight (kg) Control 692296 695498 69.4 + 96% Resistance 7032112 7004108 6974 106 Aerobic 628 + 94 6244 94 622 + 4 Combination 6452101 641499 639 + 9 SMM (kg) Control 216236 212438 209 + 5 Resistance 229 = 4.0 23.0 + 4.1¢ 23.1 1 ۳ 23° + 202 2 + 202 200433 تس Combination 20.7 = 4.0 214 + 37° 209 + 37° ASMMeight (%) Control 230 ۶ 26 2264 26 225 4 26 Resistance 241424 24.3 + 26¢ 24.6 + 264 Aerobic 230220 2344 21° 235 + 20° Combination 237427 2444 24° 243 4 26° BFM (kg) Control 290462 2984637 2984 59% Resistance 279=68 269479 273 + 5 3۵ 253456 246456 242 4 58 Combination 257+60 241456 246 +58 

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29.2 + 37 28.1 + 43 26.6 + 39 269 + 28 41.0 + 46% 38.8 + 63 38.6 + 49 38.3 + 5.5 26,6206 ل 140.9 26.1 + 1247 30.9 + 118.4 30.6 + 107.4 18.6 + 9.0 22.1 + 68°¢ 18.3 + 73 23.1 + 7.0 46.83 + 23.23 61.93 - 5 46.20 + 20.28 54.33 + 24.07% 29.3 + 39° 282 + 43 267 + 38 268 + 29 40.5 + 472° 38.7 + 64° 39.0 + 46° 37.4 + 53 139.6 + 25.920 124.0 + 22.4 114.4 + 35.4 974 + 36.3 197 +1 1 19.2 + 67 243 + 7.0 47.21 + 23.89 65.49 + 24.05% 51.29 + 22.70" 56.75 + 24.61% BMI (kg/m?) Control 29.0 + 3.9 Resistance 283444 Aerobic 26.8 +38 Combination 272429 PBE (%) Control 39.8 2 5 Resistance 39.7 + 5.6 Aerobic 40.0 ‏2د‎ 4 Combination 39.7 + 5.8 VFA (cm?) Control 135.6 + 25.6 Resistance 130.4 + 26.0 Aerobic 122.2 + 35.7 Combination 111.9 + 31.5 Grip (kg) Control 222495 Resistance 20.0 + 7.0 Aerobic 221476 Combination 26.4+7.5 Back extensor (kg) Control 90.07 + 24.89 Resistance ۰ 50.45 + 23.32 Aerobic 43.37 + 21.27 Combination 46.73 + 18.90 

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19.27 + 7.51 24.41 + 5.974 20.11 + 7.31 21.79 + 7.04 3.44 + 1.28 414 + 227 3.68 + 1.54 4.51 + 113 757 + 19.34 د 24.77 6.18 + 19.39 7.15 + 21.68 3.42 + 130 4.23 + 2.06" 3.43 + 1.44 ل 4.55 Knee extensor (kg) 20.81 + 7.90 20.57 + 5.29 19.82 + 7.59 19.99 + 6.83 4.39 + 1.27 4.07 + 1.97 4.07 + 1.43 4.49 + 1.47 Control Resistance Aerobic Combination IGF-1 (ng/mL) Control Resistance Aerobic Combination ‎Respectively mean significantly greater than the result for the RT,‏ فعطد ‎AT, CT, and CON groups (P < .05). ‎ASM, appendicular skeletal muscle mass; BFM, body fat mass; combina- tion training; AT, aerobic training; PBF, percent body fat; RT, resistance training; SMM, skeletal muscle mass; VFA, visceral fat area. 

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Figure 2. Influence of different exercise modes on the (A) ASM/Weight, (B) SMM, (C) BFM, (D) VFA, (E) Grip, (F) Back extensor, (G) Knee extensor, and (H) IGF-1 concentration of older adults with sarcopenic ae abe a م ‎Ps]‏ ی سر ‎١ 4‏ 3 ot ‘bed 2° ۲ 5 Sf. 3 ao ‎Bas‏ ال ‎۳ ‏ا 8 ‎7 ‎5 2» ‎3 3 ‏اوم ا وی ‎ ‎mo ‎180 ‎160 ‎Mo ‎260 ‎360 ‎GRIP( kg) ‎KNEE EXTENSOR (kg) ‎ ‎ ‎ 

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Accepted Manuscript ‏مه مسمیر‎ 20 March 2017 Bevaca uae 24 Apn 2017 (Accepted date 32 Ray 2017 Vitamin B12 deficiency might be related to sarcopenia in older adults Esra Ates Bulut, Pinar Soysal, Ali Ekrem Aydin, Ozge Dokuzlar, Suleyman Enire Kocyigit, Ahmet Turan Isik 403 patients, were included study. All cases’ skeletal muscle mass (SMM), walking speed and hand grip strength were recorded by bioimpedance, 4 meter walking test and hand dynamometer respectively. Sarcopenia was accepted low SMM with low handgrip strength or low physical performance. Dynapenia was defined as handgrip strength <30kg (men) and <20kg (women). The prevalence of sarcopenia and dynapenia was 24.8% and 32.0%, respectively. 

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Decreased muscular strength and / or walking speed together with decreased muscle mass were evaluated as sarcopenia. Without any decrease in muscle mass, decreased muscle strength was defined as dynapenia. Results: In the patients with sarcopenia, mean age, osteoporosis and frailty were higher, and MMSE (Mini Mental State Examination) , and instrumental ADL (Activity of Daily Living) scores were lower than the patients without sarcopenia (p<0.05). In addition lean body mass, total skeletal mass and skeletal muscle mass index were lower in the patients with vitamin B12 levels less than 400 pg/mL compared to higher than 400 pg/mL (p<0.05). And Sarcopenia, might be related to vitamin B12 deficiency. 

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Table 2. Comparison of the body composition of patients according to Vitamin B12 >400pg/mL, n=163 72,947.81 0.30 22.97410.01 0.65 49.4245 27.9745.38 46.9249.06 7.744143 Vitamin B12 <400pg/mL 1-40 22719 200 157 22. 4928.88 45 5-14 26.0124.51 vitamin B12 level [Lean Body Mass (kg) ‘Sceletal Muscle Mass (kg) [Muscle (kg) [Sceletal Muscle Mass Index (sceletal muscle mass/height2) 

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Highlights: QSarcopenia and dynapenia are new geriatric syndromes which are related to worse health outcomes, morbidity, mortality and disability. Qmicronutrients may play role in the pathogenesis of sarcopenia, especially vitamin B12 may cause reduction in muscle strength and walking speed, and postural instability. Qvitamin B12 deficiency is common older adults so it should be checked periodically and treated properly. 

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JAMDA | ‏تسس‎ | JAMDA ELSEVIER journal homepage: www.jamda.com Original study Interventions for Treating Sarcopenia: A Systematic Review and ۰ Mark Meta-Analysis of Randomized Controlled Studies Results: this review investigated the effects of exercise (4 RCTS), nutrition (5 RCTs), drug (1 RCT), and combination (4 RCTs) on muscle mass, strength, and function in older people with sarcopenia. Very low to low-quality evidence suggests that (1) exercise interventions may play a role in improving muscle mass, muscle strength, and walking speed in 3 months of intervention; (2) nutritional interventions may be effective in improving muscle strength in 3 months of intervention; (3) as drug intervention, selective androgen receptor modulator had no clear effect on muscle mass, strength, and physical function; and (4) a 

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others Thee were 4 groups (1) exercise + nutiton, (2) exer, (3) ourtion, and (4 health education There were 4 groups: (i) exercise + nutrition, (2) exercise, 3) oumtion, and (4) health edcaton, Thre were 4 groups: (exercise = nutrition, (2) exercise, (3) ‏.اسه‎ ‎and (4) heath education. Thee were 3 groups: WAY of (1) ow frequency of (2) metiam frequency, and of (3) igh fequency, and no WAY, thers ‘There were 4 groups: (1) exercise + nutrition, (2) exercise (3) nutrition, and (4 eal education There were 4 groups: (1 exercise = nuiton, (2) exercise (3) nutstion, and (4) health education. There were groups: 1) everest + nutrition (2) exercise (3) nutrition, and (4) health education ‘There were 3 groups: 1) EAA power (2) EAA mi, and 3} placebo, ‘Al participants had resistance taining program 3 times a week. There wee 2 groups: (1) protein and (2) placebo. Both groups had resstance traning program 3 times a week, Contra 7. Nttion: amino acl supplementation 2. Health education 1. Nutiton: tea caechin supplementation 2 Health education 1, Nutian: amino ald and tea atechin supplementation 2. Health education No walning Control 1. verse 2 Health education 1 Exercise 2 Health education 1 Exercise 2 Health education 1. Placebo (rice milk) Pacebo (sic) ‘Table 2 Characteristics of Exercise Intervention Protacl Study, Year Gas Contol.n_Bxercse interventon| 1۳6۵:202۷ 7 35 {0-minute comprehensive taining program twice a week Kimeta.2039 64 ‏م‎ 60-minute comprehensive traning pogram twice a week Kimetal206" 7 60-minute comprehensive taining program twice a week Weietal20162 20 60 Wav waining Tables Characteristics of Nutritional Intervention Protocol ‎Case,n_Contal, National Intervention‏ رق ‎1۵۵۱۵:2۵12 77 8 EAA(2 g) supplementation (2times ada: 6 g dally) ‎Tea catechin (540 mg)‏ يو مه زو تعس ‎supplementation (daily)‏ ‎Kimeta.206" 0 EAA (3 g) and tea catechin (540 mg) supplementation (daily) ‎Malaisetal 2016" 16 ‏مد‎ Protein (12g), with EAA (7g), supplementation (daily) ‎Ueieblketal 2015 26 7 Collagen peptide (15g) ‎supplementation (daily) ‎ ‎ ‎ ‎ ‎ ‎ 

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Others ‘There were 4 groups: (1) exercise + ‏تمه‎ ‎(2)erercis, (3) nation, and (4) heath education. ‘Tere were 4 groups: (I)enercie = nutrition, (2) exerci, (3) sution, and (4) beat education. There were 4 groups: (I)etercie + nuxion, (Q)exercis, (3) rutiton, and (4) health education. ‘Tere were2 groups (1) protein ad (2) placebo group. Both groups had esstance training program 3 times a week, Control Exercise or Nuvton| Alone ۱ ‏سس‎ (same as let alone 2 Nuuition (same as fet) one 1 Brrcse same as left) alone 2 Nuition (same as le) alone 1 Exercise Same as et) alone 2. Nunition (same sl) alone ۱ ‏تس‎ same as let) alone Intervention: Exercise Pls Nutrition 60-minute comprehensive waning program twice a week and EAA (G12) supplementation (2 times a day: 6g call) ‘50-minute comprehensive taining Program twice a week and tea catecin (540 mg) supplementation (daly) 60-minute comprehensive taining program twice a week and EAA 3) and tea ctechin (540 mg) supplementation (dll) 60-minute resistance training with fitness devices times a week and collagen peptide (15 2) supplementation (dail) Tables Characteristics of Combined Intervention Protocol Conta 39 39 2 2 35 4 27 عت 38 38 2 2 36 36 26 study, Year Kim eta 2012" im etal, 2013" Kim etal 2016" ‘ead et al, 2015" 

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‎nutrients‏ يي ‎Review ‎Exercise and Nutrition Strategies to Counteract ‎k ', Pablo Massanet?, Yves Boirie 25, ‎ ‎Sarcopenic Obesity ‎Inez Trouwborst '®, Amely Verreijen ', Robert Meme Peter Weijs ‘4 and Michael Tieland + ‎Receivact 17 April 2018; Accepted: 9 May 2018; Published 12 May 2018 

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“Table 1. Execic and nuston strategies to improve body compotion and physi performance in sarcopenic ‏واه‎ ۲۲ 0 Deion ren ‏ا‎ ‎|] ‏سه‎ ‏اسر 1 حت‎ meena Ta ‏سس‎ a SRD S30 das ams at poet ۳ ‎SAG ca at cont‏ مس لساك ‎oe INLET Sac‏ منت ‎SiN ie CE Wp aE‏ ود ‎Lomi) we anid Rem rm Mammy stage Steg peat‏ | ‎ana See‏ 7 ری ها اف اه سس سس مدس هر هه ‎Omer‏ ‏مضه چد ما قاس هو مهد کی ها ‎SS‏ ‎Armas SE 08‏ ‎et eee Sere‏ مه مه تون ‎a (BPS. SML gaitepeed and CS‏ 3 هه سر که اه الک وم لا و ع 39 و[ ‎team)‏ تسه سنا ‎TE AGH‏ 7 مس ‎p< O00‏ ,98-29 990 وه ‎HGS hy:‏ عه ‎ft‏ ‏اس ‎ee ee‏ مود ‎ann‏ ‎on‏ هلا تست نش ‎[0 rea Same ‎ ‎ ‏كنار ل سسا ما تج يي هي اسلف ۳ ‎Sco ‏ی و‎ pooh aaah me a ‏و‎ TR SEI 7Igve 22 200g Sa pm ‏ا ا و ۲ ميد ‎0 RE ‎Re rag AB SEA NE. ABS5SEU4‏ ا سات انا اس سس ‎Soe cE wher abr Taig ewan RA RSS = CET‏ ‎maa) wt PE Sant GS mm ‏مق و‎ ‎| ee. Thal gone of mips Sadie & dapaped, ‏جه ماك رسيا"‎ daphped ‏مودت عسوي مجم انا اسه از‎ to the coal gu OMB mae Sate Schade ne WS Mya pnt SA seal oa de VER nal te Bren ara Aso ‏ا سام‎ ۳ ate CSharp een Ppa tga PP prforsianc wt, EAA ari ais Standard Niet pice ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ ‎ 

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combination of a moderate weight loss diet, with concurrent exercise a high protein intake (21.2 g/kg/day), 

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Review Diet Quality and Sarcopenia in Older Adults: A Systematic Review Ise Bloom !2*, Calum Shand !, Cyrus Cooper !2’, Sian Robinson !2@ and Janis Baird! Nutrients 2018, 10, 308; doi:10.3390//nu10030308 Healthier diets: ter fruit and vegetable consumption ter consumption of wholemeal cereals and oily fish 2r intakes of vitamin D and Omega-3 long-chain polyunsaturated fatty acids (LC 2r antioxidant and protein intakes 

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Review (Glnical Nutnition 37 (2018) 121-1132 Does nutrition play a role in the prevention and management of sarcopenia? Table 1 Meta-analyses, published between 2004 and 2014, of supplement (isnint) rials to prevent falls (OR odds ratio; RR relative risk; RaR rate ratio). Effect of supplementation on falls 2004 —_Bischoff-Ferrari HAet al. [88] -22% [OR 0.78 (95% Cl 0.64, 0.92)] 2007 Jackson C et al. [89] —12% [RR 0.88 (95% Cl 0.78, 1.00)] 2008 O'Donnell $ et al. [90] ~34% [OR 0.66 (95% Cl 0.44, 0.98)] 2008 Richy F etal. [91] —21% [RR 0.79 (95% CI 0.64, 0.96)] 2009 —_Bischoff-Ferrari HAet al. [92] _ — 19% [RR 0.81 (95% CI 0.71, 0.92)] 2010 Kalyani RR et al. (93] —14% [RR 0.86 (95% CI 0.79, 0.93)| 2010 Michael YLet al. [94] —17% [RR 0.83 (95% C1 0.75, 0.91)] 2011 Murad MH et al. [95] ~14% [OR 0.86 (95% C1 0.77, 0.96)] 2012 Cameron ID et al. [96] —37% [RaR 0.63 (95% C1 0.46, 0.86)] 2014 Bolland Met al. [97] —5% [RR 0.95 (95% Cl 0.89, 1.02)] 

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Mixed muscle protein FSR Basal Clamp Basal Clamp Before After Fig. 5. Mean (+SEM) mixed skeletal muscle protein fractional synthesis rate (FSR) during postabsorptive conditions and hyperaminoacidemic-hyperinsulinemic clamp, before and after 8 weeks of supplementation with omega-3 fatty acid supplementation. , antioxidant nutrients [ (500 mg/day) and (117.5 mg/day)] and long-chain polyunsaturated fatty acids ( )is useful for sarcophrenia. 

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REVIEW Published online: 08 February 2017 Physical activity and exercise as countermeasures to physical frailty and sarcopenia requency and duration of training ‎Centr sed physical asi Home-based physical act‏ ع ا ‎ ‎ ‎ ‎Adoption (weeks Twiee weekly 1 timerweek (weeks I~) 2 times/week (weeks 4-8) Upto 3-4 times week (weeks 8-52) Maintenance (week S2—end of the Twice weekly Upto 3-4 times'week teal) ‎ ‎ 

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* ngth tri ig component of the physical activity intervention Strength training focuses primarily on five lower extremity Exercises. The goal is to include three sessions of strength training (RPE = 15-16) throughout the intervention. Each strength exercise includes two sets of ten repetitions each, with 1-min rest in between. At each exercise session, participants complete one strength training exercise from all of Ue fi Se fora total of five exercises. Upper body exercises are incorporated at the end of the session. Each month, one upper body exercise is chosen by the trainer and performed at the end of the group session. Balance training protocol Participants perform balance training according to ‘ve different levels of difficulty. Progression to the next level occurs when all exercises of a certain level can be performed correctly. Balance exercises are performed once a day every day throughout the intervention. 

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Table 2 Strength traming exercises in SPRINTT Enccution mode Paricipant stands i front ofa chair aims their burtocks into the chair and slowly lowers themselves snta sa sezted postion; pase for a breath in the sested position: participant stands up slowy pushing up From their e's though their lower legs, thighs, hips and butioks ‘Perisipant stands behind a chair. Keoping thighs side-by-side, participant its their fot up towards the but- tocks und the upper and lower leg forms a 90° angle (2 sts of 10 rpaitions fer each leg) Panicipant stands behind a chair with hands resting zlong the top of the char hack. Participant sky fs ‘one eg Sraight back without bending thelr knee and holds the position for 1s 2 sets oF 10 repetitions for cach kg) PPrsicipant stands in the sume position as the hip extension exercise. Participant slowly bends the knce towards their chest, without bending at th waist or hips aud holds the postion for | s 2 ets of 1D ‏توح‎ ‎lions foreach lex) PPanicipant iso sit back in a chair. Keeping the foot flexed. te participant raises one leg until ts fully ‘extended (2 sets of 10 repetitions for each lez) Prsicipant is i the same positon and moves thor leg as doscribed bofoo. With the knoe as straight ae possible, participants rotate their right ankle § ime to the right and then S times o the left 2 ets of 10, repetitions for each es) Participant stands straight with Rec together and hands westing on the back ofa chais. Keeping dei toes Polmed staight ahead participant lifts one ez out 0 he side unl Ueir foots 15-20 em off dhe ground (2 sof 10 repetitions foreach leg) Posicipant stands up stright with foct together and ther side towards the back of the chai. Keeping their foot Hexcd, the participant lifts one leg uni their foot is 15-20 ema off the ground, then makes large clock ‘wise circles, while kee png thie foo lifted and leg extended (5-10 circles for cach es) Porsicipant stands stright with fet together and hands resting on the hack ofa cit. The participant slowly raises thelr body as high as possible onthe balls of thelr feet (2 sets of 10 repetitions) PPorisipant stands behind a chair with fot slightly apart and then points thir toes out to the side, with hands resting onthe back ofthe chair Participant rises their body on tho balls of thei oot (2 sets of 10 ‏نموم‎ ‎tions) 355 2 Wide leg squat YD Group 2 (with ankle weivhts) Standing eg cul Hip extension Hip fexion SD Group 3 (with ankle weighs) Knee extension Knoe extension and ankle cic SD Group t Side hip abe Leg circles دوس جع Toe stand Toes out calf raise 

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‘Table 3. Uppor-body exercises in SPRINT Exeuutioa mode Participant stands facing wall approximately 60 cm away and places their palms flaton the wall. Par- ticipant leans towards the wall, keeping their elbows tucked in until their nose is almost touching the wall. After holding this position for Is, the participant returas to the starting position until their arms are straight (10 repetitions) Participant stands or sits in a chair while holding an ankle weight in one hand, with their palm facing forward. Keeping the wrist straight, the participant raises thoi forearm up towards their chest and hholds this position fo |. The participant brings their arm back down slowiy, keeping their hands facing their chest (10 repetitions) Pagticipant stands with feet hip-width apart while helding an ankle weight in each hand, The par= ticipant raises both arms forward into a“Y" position with thumbs facing up. After holding this position for Is, the participant returns io the starting pasition (10 repetitions) Participant sits in a chair with armrests, Participant grabs the arms of the chair with each hand and pushes slowly off the chair. After holding this postion for Is, the participant retums tothe starting position (10 repetitions) Participant stands with feet hip-width apart while holding an ankle weight in each hand, Participant brings their arm beck slowly past their hips oras far as comfortable. keeping their elbow straight. After holding this position for Is, the participant returns tothe starting postion (10 Participant sits holding a tennis ball in one hand, Participant geatly squeezes the tennis ball and holds the position far 5s (10 repeitions) Pagticipant sits wit feet shoulder-width apart holding an ankle weight with the hand crossed over to the opposite hip with their palm facing inwards. Participant lifts their arm up and scross their bedy ending with the palm facing outwards. After holding this position for 1 s, the participant retums to the starting position (10 repetitions) Participant sits up straight in a chair with their feet flaton the ground, head facing forward, and a towel or pillow supporting the lower hack. Participant turns their head slowly to the right as far as is comforiable. Afier holding the position for |, the participant brings their head slowly back to the stating position; then, the participant turns their head slowly tothe let as far as is comfortable, holding the position for 1 s (5 repetitions) ‘Wall push-up Bicep cul محقم سيق Chair push (triceps extension) ‘Triceps kickback Teanis ball squeeze Lawn mower pull Seated neck turn Exewise Exercise | Exercise 2 Exercise 3 Exercise 4: Exercise 5: Exercise 6: Exercise 7 Exercise 8: 

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everson LM) AE ‏و‎ 0 | REVIEW Nutrition and physical activity in the prevention and treatment of sarcopenia: systematic review Conclusion: Physical exercise has a positive impact on muscle mass and muscle function in healthy subjects aged 60 years and older. The biggest effect of exercise intervention, of any type, has been seen on physical performance (gait speed, chair rising test, balance, SPPB test, etc.). We observed huge variations in regard to the dietary supplementation protocols. Based on the included studies, the interactive effect of dietary supplementation on muscle function SbeGerswarrdeeterogeneous in terms of protocols for physical exercise and dietary supplementation (proteins, essential amino acids, creatine, B-hydroxy-B-methylbuthyrate, vitamin D, multi-nutrients, or other). 

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9 REVIEW ARTICLE The Potential of B-Hydroxy-B-Methylbutyrate as a New Strategy for the Management of Sarcopenia and Sarcopenic Obesity Essential amino acid supplementation, particularly b-hydroxy-b- methylbutyrate (HMB), a metabolite of leucine that is produced in skeletal muscle, has been evaluated in several studies as a nutritional approach to enhancing muscle protein synthesis in healthy or frail elderly subjects. Studies performed in in vitro conditions show that HMB may be effective in the treatment of muscle wasting, increasing myogenesis, reducing muscle apoptosis, and having a positiv on muscle protein turnover. HMB supplementation resultg increase in skeletal muscle mass and strength in the elder/ effect is even greater when combined with physical exercise. 

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POTENTIAL NUTRITIONAL INTERVENTIONS Increased dietery AA Fish oll Healthy protein intake Supplementation HMB n-3 PUFA diet کم مگ | مسد متها ‎RESETANGE 2‏ 2۳/۳۱9 Muscle Mass. Agerelated sarcopenia Secondary sarcoperia (activiy-related sareopenia, siseese-related sarcoperia) Age ig. 1 Hypothetical links between nutrition and sarcopenia. AA amino acid, HMB B-hydroxy-B-methylbutyrate, PUFA polyunsatu- rated fatty acids 

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Improves protein anabolism in the Protein Synthesis gastrocnemius muscle by increasing mTOR phosphorylation and, consecutively, attenuates ‎body weight and muscle loss in‏ بو 0 لت ‎T “—~ hepatoma-induced cachexia animal‏ — ‎p7056k 4E-BP1 elF2B model [10]‏ = ‎mTOR ‎| ‎Activation and Proliferation of, MRFs + HMB ‎ ‎ ‎ ‎Satelite Cells Ubiquitin ligases Increases in vitro activation and 25208 roliferation of satellite cells and ‏و امس بن‎ Proteasome activity caspase 8 and [14] triggered by cell starvation [11] | ‎Proteolysis ‎Fig. 2 In vitro effects of HMB. mTOR mammalian target of rapamycin, HMB b-hydroxy- bmethylbutyrate, MRFs myogenic regulator factors, IGF-1 insulin growth factor-1 

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Conclusions: HMB is present in very small quantities of different dietary components, such as grapefruit, avocado, asparagus, and catfish. The recommended dose of HMB is 3 g/day, as suggested by the majority of studies, but since only 5% of leucine is metabolized into HMB in muscle cells, supplementation (nutritional Supplementation) is necessary in the elderly. since HMB can be used as an efficient nitrogen-free stimulator of protein and energy metabolism in skeletal muscle and adipose tissue, we suppose that may be used as a viable alternative to leucine in the treatment of sarcopenic obesity in the elderly. 

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2017 Wolters Kluwer Health, Ine, GRD Fast digestive proteins and sarcopenia of aging Yves Boirie® and Christelle Guille? Ospeed of protein digestion depends not only on proteins sources, but also on food matrix, texture, technological processes and associated calories. Qusing fast digestive proteins is of major interest to overcome ‘anabolic resistance’ of aging for limiting sarcopenia. OFast digestive proteins are efficient for improving muscle mass and muscle function in older individuals through the postprandial changes in amino acid availability. OThe anabolic effect of fast digestive proteins, especially whey protein, is amplified by physical exercise. optimization of nutritional strategies by combining whey proteins with vitamin D, leucine, omega 3 or antioxidants and with exercise might enhance and prolong the beneficial effect on muscle anabolism of fast proteins in older adults. 

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Experimental Gerontology 115 (2019) 104-113 Contents lists available at ScienceDirect Experimental Gerontology journal homepage: www.elsevier.comilocatelexpgero The effects of a combined bodyweight-based and elastic bands resistance ® training, with or without protein supplementation, on muscle mass, ‏تا‎ ‎signaling and heat shock response in healthy older people 5 Mauricio Krause*"'*", Domenico Crognale* , Karl Cogan’, Serena Contarelli®, Brendan Egan“, Philip Newsholme’, Giuseppe De Vito“ 

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Materials and methods (Study design): Thirty-eight healthy sedentary participants (M/F, 18/20; age, 63.5 + 4.4 y) were randomly assigned to four groups: 1) PLACEBO: no training, receiving placebo sachets; Il) NUTRITION: no training, receiving protein supplementation sachets; Ill) EXERCISE PLACEBO: training, placebo sachets and IV) EXERCISE NUTRITION: training, receiving protein sachets. The resistance training (using bodyweight and elastic bands) consisted of 45 min supervised training sessions, 3x/week for 12 weeks. Between weeks 3 and 12, the program was designed to promote muscle hypertrophy (4-6 sets, 8-15 repetitions). The training consisted of a combination of upper and lower body exercises. Thera-band exercises were progressed by increasing the resistance of the band in ascending order: red, green, blue and black respectively. Progression was determined based on rate of nerceived exertion (RPE). Participants 

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Protein supplementation and placebo: Each protein supplement dose provided 0.165 g protein kg—1 BM day—1 of median BM. The protein matrix was supplemented with 2187 mg/100 ‏و‎ powder of milk-based calcium and 57.3 mg/100 g powder cholecalciferol. Placebo consisted of an isoenergetic, non-nitrogenous maltodextrin sachet that was ingested at breakfast and midday meals. 

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sitana Reach Tost i 13 ۳ G Lan Boye ‏او‎ رمع هم ام Placebo Natron lm Exercise Placeto I Exercise Nutrition g-1. lang nite bly kasd mas and od a as seedy DXA Cand. Po ad aad ets ys pefomance Haat seagt (Chen tt Goand 1 mantra (an had echt (2) tree 50 Dar hd eomgeron me he ober td 

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۳ موه مج ‎Nation‏ سم وج - 3 ‎i‏ ‏و CF CF Co OF E 1. bor OSE Ob OP CE 3 ‏ا‎ ۴ fe SO eS OP "SE OO Oe ee HSPTOIGAPOH a | I SE OE OO OP Fig. 2. Changes in muscle protein expression 

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ved > ۱ ‘ih موم ۳ || | wea 7 Exes Paceto reese Nurean 7 i i 6 ate RA eee A Bg 1 mm erm 6 ‏مه‎ A wren A 3. Changes in transcript abundance for markers of muscle atrophy, regulators of growth, HSP70 and jnvosin’ heave chain eotanm: 

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elastic bands based resistance exercise protein supplementation was added 

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‘Trends in drug development for sarcopenia. Company of institute Brand name Component ‘Abbott Nutrition ANTTT ‘Medical food mixture Merck Sharp & Dohme MK-677 GH releasing peptide Merck Sharp & Dohme MK-0773 Anabolic steroid Novartis, BYM338 (Bimagrumab) Antibody (ActRIIB) Sanofi REGN1033 (SAR391786) Antibody (myostatin) ‘Takeda Pharmaceuticals Pioglitazone (Actos) PPAR-y agonist Johns Hopkins University Losartan ATR antagonist Mayo Clinic Omega-3 Unsaturated fatty acids National institute on Aging Anastrozole Estrogen synthesis inhibition Seoul National University Cetylpyridinium chloride Cationic ammonium compound University of Colorado ‘Acetaminophen NSAID University of Pennsylvania Ghrelin Hunger horrmone Washington University Dehydroepiandrosterone ‘Androgen precursor ‘ActRIIB, active receptor type ll; AT:R, angiotensin Il receptor; GH, growth hormone; NSAID, nonsteroidal anti-inflammatory drug; Molecular mechanisms and therapeutic interventions in sarcopenia. Review article (2017)