Rehabilitation Nutrition and Exercise Therapy for Sarcopenia

Abstract

Sarcopenia is an age-related loss of skeletal muscle associated with adverse outcomes such as falls, fractures, disability, and increased mortality in older people and hospitalized patients. About half of older male nursing home residents have sarcopenia. The diagnostic criteria by the European Working Group on Sarcopenia in Older People (EWGSOP) and the Asian Working Group for Sarcopenia (AWGS) have led to increased interest in sarcopenia. Exercise and nutritional management are crucial for the prevention and treatment of sarcopenia. Nutritional therapy for sarcopenia that includes 20 g of whey protein and 800 IU of vitamin D twice a day improves lower limb strength. Exercise therapy for sarcopenia, such as resistance training and 6 months of home exercises, improves muscle strength and physical function. Combination therapy that includes both nutritional and exercise therapy improves gait speed and knee extension strength more than either exercise alone or nutrition therapy alone. Excessive bedrest and mismanagement of nutrition in medical facilities can lead to iatrogenic sarcopenia. Iatrogenic sarcopenia is sarcopenia caused by the activities of health care workers in health care facilities. Appropriate nutritional management and exercise programs through rehabilitation nutrition are important for prevention and treatment of iatrogenic sarcopenia. Nutritional and exercise therapy should be started very early after admission and adjusted to the level of inflammation and disease status. Repeated assessment, diagnosis, goal setting, interventions, and monitoring using the rehabilitation nutrition care process is important to maximize treatment effectiveness and improve patients' functional recovery and quality of life.

Sarcopenia: Etiology, Nutritional Approaches, and miRNAs

“…Lastly, in order to continually reach improvements in mass, strength, and functional capacity, it is key to consistently incorporate progression and variation into the program. Every training variable can be adjusted over time considering the training experience of the subject and the adaptation rate on a case-by-case basis [81,87]. It is worth mentioning that it is not always possible to practice physical exercise, particularly strength training, for bedridden subjects and/or long-term patients due to chronic diseases such as cirrhosis, COPD, or severe renal insufficiency up to dialysis.…”

Rehabilitation nutrition for individuals with frailty, disability, sarcopenic dysphagia, or sarcopenic respiratory disability

“…The process of rehabilitation nutritional care is a systematic problem-solving method used to assess nutritional status, sarcopenia, and nutrient intake in disabled or frail elderly people [ 1 ▪ , 2 ]. Rehabilitation nutritional care involves five steps: rehabilitation nutrition assessment and diagnostic reasoning, rehabilitation nutrition diagnosis, rehabilitation nutrition goal setting, rehabilitation nutritional intervention, and rehabilitation nutrition monitoring (Fig.…”

“…The most important step in the process of rehabilitation nutritional care is rehabilitation nutrition goal setting. Goal setting should be performed in accordance with the concept of specific, measurable, achievable, relevant, and time-bound (SMART) [ 1 ▪ , 2 ]. For example, nutritional improvement and ADL independence are not SMART goals.…”

“…Prevention of iatrogenic sarcopenia can lead to prevention of sarcopenic dysphagia. Iatrogenic sarcopenia is sarcopenia caused by the activities of doctors, nurses, or other healthcare workers in healthcare facilities [ 1 ▪ , 2 ]. The three causes of iatrogenic sarcopenia are inappropriately low activity levels, inappropriate nutritional care management, and iatrogenic diseases including polypharmacy.…”

“…Rehabilitation nutrition is a new area of research and clinical practice that has developed over the past decade mainly due to the work of the Japanese Association of Rehabilitation Nutrition members. Rehabilitation nutrition involves (1) holistic evaluation by the International Classification of Functioning, Disability and Health (ICF), and the presence and cause of nutritional disorders, sarcopenia, and excessive or deficient nutritional intake; (2) rehabilitation nutrition diagnosis and setting rehabilitation nutrition goals; and (3) improvements in nutritional status, sarcopenia, and frailty using nutritional care management in consideration of rehabilitation and rehabilitation in consideration of nutrition to achieve the highest body functions (e.g., swallowing function, activities, and participations) and quality of life (QOL) in disabled or frail older individuals [ 1 ▪ , 2 ]. Malnutrition is a cause of frailty and disability, including sarcopenic dysphagia [ 3 ▪▪ ] and respiratory sarcopenic disability [ 4 ]; therefore, nutritional management can improve frailty and disability.…”