sarcopenia, frailty, osteoporosis and senior athlete

sarcopenia definition

no universally accepted definition

*2+ SDs below values from DEXA scan

sarcopenia modifiable interventions

- resistance exercise at mod-high intensity 2-3x a week

- eccentrics at high intensity

- .8 g/kg/day for protein

sarcopenia screening scoring

4+ score is indicative of sarcopenia w/ adverse outcomes

sarcopenia obesity

skeletal muscle below SDs and body fat 27+% for men or 38+% for women

- increased fatty infiltration of skeletal muscle

- greater consequences

minimum chair height standing ability test

for pt who can't perform 5xSTS or 30 sec chair stand

- starting height at 47 cm and lowers every 3 attempts if can't do

- correlated w/ LE strength and falls risk

what is the main driver of frailty

sarcopenia

- muscle weakness the most common sx of frailty

definition of frailty

no universal definition

- decreased physiological reserve

- homeostatic instability

- multidimensional

fried frailty phenotype (know for sure)

1. unintentional weight loss (10+ lbs in a year)

2. self-reported exhaustion w/ normal activity

3. slow walking speed

4. weak grip strength

5. low PA

0/5 = robust, 1-2/5 = pre-frail, 3/5 = frail

short physical performance battery

3 sections: balance, gait speed, 5xSTS

- widely valid, reliable

frailty: 9 or <

pre-frailty 11 or <

frailty clinical practice guidelines: strong recommendations

1. frailty screening for 65+ y/o should be offered

2. frailty assessment for all older adults who screened for frailty or pre-frail

3. develop multidisciplinary plan

4. PA/exercise

when is the most effective time to intervene for frailty

pre-frail stage

RET prescription for frail adults

8 reps at 80% max?

- 8-10 exercises that target major muscle group

recommendation #2 of APTA in terms of dosing w/ older adults

avoid under-dosed strength training

what BMI levels are at a higher risk of a decrease in functional capacity

<25 and >35

do pt lose more weight on GLP-1 or lifestyle changes

GLP-1

gold standard for measuring hyperkyphosis

cobb angle

0 abnormal is >40 or 50 deg

what outcome measure is well correlated w/ Cobb Angle

occiput to wall distance

- 2+ cm is hyperkyphotic

kyphotic index

landmark of C7 and L5-S1

thoracic width divided by thoracic height x 100

- >13 = thoracic hyperkyphosis

time-loaded standing test

shoulder flexor and spinal extensor muscular endurance

- valid measure of erector spinae

HIIT benefits w/ post-menopausal osteoporosis

- improved l/s and femoral BMD, functional performance and t/s hyper kyphosis

5x5 at 80-85% 1RM supervised exercise 2x/wk

- deadlift, overhead press, back squat, jumping chin up w/ drop landing

osteoporosis exercise summary

- RET and high impact aquatic can both help

- high intensity, progressive the most helpful

- low WB has modest effect

- avoid spinal flexion and rotation exercises

can you do joint mobilizations w/ osteoporosis

yes, but I-IV are a precaution

- V is contraindicated

hormone replacement therapy w/ osteoporosis

slows bone turnover and bone loss BUT:

- increased risk of CV events and breast cancer

senior athlete fitness exam consists of

CV, strength, gait speed, flexibility and balance