sarcopenia與運(yùn)動(dòng)和營(yíng)養(yǎng)干預(yù)

Sarcopenia與運(yùn)動(dòng)和營(yíng)養(yǎng)干預(yù)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這個(gè)詞起源于希臘語(yǔ)，原意是“povertyofflesh”(缺少肌肉)?！癝arco”是前綴，指肌肉；“penia”是后綴，意流失。國(guó)內(nèi)文獻(xiàn)譯為“少肌癥”、“骨骼肌減少癥”、“肌肉衰減征”、“老年性骨骼肌減少癥”等等。在1989年由Irwin第一次用來(lái)描述老年性的肌肉減少和力量衰減。

2010年，Sarcopenia歐洲工作組(EWGSOP)將少肌癥定義為：“老年人骨骼肌質(zhì)量和骨骼肌力量及功能下降的一種病征”，主要強(qiáng)調(diào)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肌少癥的診斷及分級(jí)標(biāo)準(zhǔn)

Criteriaforthediagnosisofsarcopenia

1、低肌肉質(zhì)量（Lowmusclemass）2、低肌肉力量（Lowmusclestrength）

3、低身體功能表現(xiàn)（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臨床表現(xiàn)

①體力活動(dòng)降低：隨著年齡的增長(zhǎng)，人體下肢功能逐漸減退，這種下肢功能降低的主要原因并非是肌肉數(shù)量的減少，而是由于肌力的下降。②情緒障礙：骨骼肌功能的退化影響老年人的體力狀況，使老年人的心理狀態(tài)失常，并相繼出現(xiàn)焦慮、抑郁等情緒波動(dòng)。③誘發(fā)骨質(zhì)疏松：骨骼所承受的負(fù)荷主要來(lái)自于肌肉的主動(dòng)收縮，而非體重，老年人的肌力呈衰退狀態(tài)，骨強(qiáng)度稍大于肌力，骨骼相對(duì)處于廢用狀態(tài)整理ppt肌少癥應(yīng)是老年個(gè)體的多重變化加乘所引起的：(1)年齡造成的肌肉神經(jīng)組織變化，加上相關(guān)賀爾蒙量（testosterone,growthhormone）的減少；(2)營(yíng)養(yǎng)相關(guān)的變化－主因於蛋白質(zhì)和能量的攝取不足或吸收不良，加上腸胃道及用藥等問(wèn)題；(3)相關(guān)疾病造成的發(fā)炎、器官損傷、臥床等；(4)活動(dòng)量減少甚至不活動(dòng)造成的肌肉流失。因此，對(duì)於肌少癥的防治，除疾病造成的原因應(yīng)先消除外，運(yùn)動(dòng)訓(xùn)練搭配適當(dāng)營(yíng)養(yǎng)補(bǔ)充（主為蛋白質(zhì)），目前被認(rèn)為是具成效的。然而哪些運(yùn)動(dòng)細(xì)節(jié)及如何補(bǔ)充？在運(yùn)動(dòng)前中後？……，都需進(jìn)一步研究。

整理ppt整理ppt整理ppt整理ppt肌肉減少癥(Sarcopenia)最早由Ev