Search Results (47)

Chronic Obstructive Pulmonary Disease (COPD) is a multifactorial condition associated with significant systemic complications such as cardiovascular disease (CVD), metabolic disorders, muscle wasting, and sarcopenia. While Body Mass Index (BMI) is a well-established indicator of obesity and has prognostic value in COPD, its role in predicting disease outcomes is complex. Muscle wasting is prevalent in COPD patients and exacerbates disease severity, contributing to poor physical performance, reduced quality of life, and increased mortality. Additionally, COPD is linked to metabolic disorders, such as dyslipidemia and diabetes, which contribute to systemic inflammation and worse prognosis and, therefore, should be treated. The systemic inflammatory response plays a central role in the development of sarcopenia. In this review, we highlight the mixed efficacy of statins in managing dyslipidemia in COPD, considering side effects, including muscle toxicity in such a frail population. Alternative lipid-lowering therapies and nutraceuticals, in addition to standard treatment, have the potential to target hypercholesterolemia, which is a coexisting condition present in more than 50% of all COPD patients, without worsening muscle wasting. The interference between adipose tissue and lung, and particularly the potential protective role of adiponectin, an adipocytokine with anti-inflammatory properties, is also reviewed. Respiratory, metabolic and muscular health in COPD is comprehensively assessed. Identifying and managing dyslipidemia and paying attention to other relevant COPD comorbidities, such as sarcopenia and muscle wasting, is important to improve the quality of life and to reduce the clinical burden of COPD patients. Future research should focus on understanding the relationships between these intimate mechanisms to facilitate specific treatment for systemic involvement of COPD. Full article

Background/Objectives: Sarcopenia is an age-related muscle disease that reduces strength and function in older adults. Exercise is a key intervention, but existing protocols vary widely and often lack adaptation to sarcopenia severity. The present study aims to review the effectiveness of exercise protocols developed after the EWGSOP2 consensus and evaluate their adaptation to sarcopenia severity stages. Methods: This systematic review followed PRISMA guidelines. PubMed and Scopus were searched for studies published after the EWGSOP2 consensus involving participants of 65 years and over with primary sarcopenia and managed through exercise-only interventions. Risk of bias was assessed with the Cochrane Risk of Bias tool, and quality and transparency of exercise intervention were assessed with the Consensus on Exercise Reporting Template. Results: Ten studies met the inclusion criteria, with a total of 558 participants. Most interventions included resistance training, often within multicomponent programs. Statistically significant improvements were reported in muscle strength, mass, and physical performance. Additional benefits included enhancements in sleep quality, respiratory function, and specific biomarkers. However, only two studies classified sarcopenia severity, and reporting quality varied considerably. Conclusions: Exercise interventions, especially multicomponent and individualized protocols, are effective at improving outcomes related to sarcopenia in older adults. However, better alignment with diagnostic classifications and standardized reporting are needed to improve clinical translation and program replication. Full article

Background/Objectives: In the context of active ageing, functional assessment is key to preserving autonomy in older women. The six-minute walk test (6MWT) is a practical tool for estimating general health, but its results can be influenced by various factors. This study analysed cardiorespiratory variations during the 6MWT in older women according to their physical activity level and age-related variables such as pain, sarcopenia, frailty, and motivation to exercise. Methods: A total of 163 older women with musculoskeletal pain, but without cardiac or respiratory conditions, were classified into groups with high (HPA), moderate (MPA), and low (LPA) physical activity. During the 6MWT, heart rate (HR), dyspnoea, and oxygen saturation (SpO₂) were recorded. Pain, sarcopenia, frailty, and motivation to exercise were also assessed. A repeated-measures multivariate analysis of (co)variance (RM-MANCOVA) was performed. Results: The results showed differences in HR depending on the level of physical activity, conditioned by sarcopenia (p < 0.05) and walked distance (p < 0.001), and in dyspnoea conditioned by pain perception (p < 0.01) and social (p < 0.001) and psychological (p < 0.05) motivation to exercise. There were also differences in SpO₂ depending on the level of physical activity (p < 0.0001). There were differences between the HPA group and both the MPA and LPA group, which had higher HR, higher dyspnoea, and lower SpO₂ when undergoing the 6MWT test. Conclusions: To accurately interpret 6MWT results in older adult women, it is essential to consider physical activity level, perceived pain, sarcopenia, and motivation to exercise, as these factors influence HR, dyspnoea, and SpO₂. These variables should guide physical activity recommendations for healthy ageing. Full article

Background: Sarcopenia is characterized by low muscle mass and strength, as well as impaired physical performance. Older adults with sarcopenia experience decreased cardiorespiratory fitness. Physical exercise is recommended for the prevention and treatment of sarcopenia. Virtual reality (VR) exercise was introduced to improve physical activity. However, the effect of VR on cardiorespiratory function in older adults with sarcopenia has not been fully explored. This study aimed to explore the effects of home-based VR aerobic exercise combined with resistive exercise on cardiorespiratory performance in community-dwelling older adults with sarcopenia. Subjects and Methods: In a randomized controlled trial, 53 older adults with sarcopenia were divided into a home-based VR (n = 26) and a control group (CG; n = 27). The VR program combined aerobic and resistance exercises, performed three times per week for 12 weeks, while the CG received knowledge regarding the benefit of exercise and continued with their regular daily activities. All participants were required to undergo respiratory muscle strength and functional capacity tests before and after the 12-week intervention. Two-way mixed repeated ANOVA was conducted to compare within and between groups in cardiorespiratory performance. Results: The home-based VR exercise group showed significant improvement in pre-post (i.e., maximal inspiratory pressure (12.96 ± 1.49 cmH₂O), maximal expiratory pressure (13.73 ± 1.72 cmH₂O), functional capacity (28.32 ± 3.48 m), and between-group (maximal expiratory pressure (F (1,51) = 10.446, p = 0.002, np² = 0.170). In contrast, the CG displayed a reduction in maximal expiratory pressure (−3.93 ± 1.69 cmH₂O, p = 0.024) and functional capacity (−10.39 ± 3.42 m, p = 0.004) after the 12-week program. Conclusions: The home-based VR program provides older adults with sarcopenia an alternative exercise modality that can improve their cardiovascular performance. Full article

Background: Sarcopenia, defined as the progressive loss of skeletal muscle mass and strength, is a critical predictor of morbidity and mortality in patients with cirrhosis. In chronic liver disease, sarcopenia exacerbates adverse clinical outcomes and deteriorates quality of life. Physical activity, particularly resistance training, has demonstrated beneficial effects in reversing muscle depletion in various chronic conditions. Aim: This systematic review aimed to evaluate the impact of resistance training on sarcopenia among cirrhotic patients, with a focus on both pre-liver transplant and post-liver transplant populations, to improve clinical outcomes and enhance quality of life. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. PubMed/MEDLINE databases were searched for randomized controlled trials (RCTs) using a standardized search command combining MESH terms and Boolean operators. Studies meeting eligibility criteria and reporting improvements in sarcopenia following resistance training were selected for data extraction. Results: Out of 109 references identified, 12 RCTs were included—10 in pre-transplant and 2 in post-transplant populations. Across studies, resistance training led to measurable improvements in key outcomes: peak VO₂ increased by up to 5.3 mL/kg/min, 6 min walk distance improved by 18–97 m, quadriceps muscle thickness increased by up to 1.05 cm, and grip strength gains ranged from 0.4 to 3.8 kg. Postoperative studies reported reductions in fatigue severity scores and length of hospital stay, along with improvements in respiratory pressures and peripheral muscle strength. Conclusions: Resistance training is effective in ameliorating sarcopenia in cirrhotic patients, thereby enhancing pre-transplant status and postoperative quality of life. Clinically, structured exercise programs should be routinely implemented. Full article

Objective: The use of transcatheter aortic valve implantation (TAVI) has expanded in patients with severe aortic stenosis who are deemed inoperable. However, sarcopenia may be a determining factor in their survival. The aim of our study is to assess the impact of sarcopenia, evaluated by computed tomography (CT), on mortality in this patient population. Methods: Patients with severe aortic stenosis undergoing follow-up after TAVI at Hospital Universitario de la Princesa were recruited. Body composition was analyzed using routine CT scans and open-source software. Survival analysis was performed, and correlations between body composition parameters at the T12 and L3 vertebral levels were assessed. Results: Our sample comprised 97 subjects. Time to mortality was associated with diabetes mellitus (p = 0.050), atrial fibrillation (p = 0.02), and respiratory disease (p = 0.03). Interestingly, sarcopenia (p = 0.039) and normal-density muscle area (p = 0.025) were also associated with time to mortality, with the association between sarcopenia and time to mortality becoming stronger after adjusting for covariates (p < 0.001). The correlation between different body composition parameters at the T12 and L3 vertebral levels was substantial and statistically significant. Conclusions: The use of CT to assess sarcopenia in patients with severe aortic stenosis undergoing TAVI is highly valuable and can predict time to mortality. Sarcopenia should be considered as a relevant parameter in the comprehensive evaluation of these patients. Full article

This single-center retrospective observational study investigated the association between changes in body composition during hospitalization and outcomes in patients with severe coronavirus disease (COVID-19) pneumonia. Body composition was assessed using chest computed tomography (CT) within 3 days of intensive care unit admission and follow-up CT within 14 days. The study population comprised 89 adult patients, among whom 57 survived. The median APACHE II score on admission was 16. Initial CT scans showed that the iliopsoas muscle volume, sum of the pectoralis major and minor muscle areas, and erector spinae muscle (ESM) area were significantly larger in survivors than in non-survivors (p = 0.019, 0.011, and 0.001, respectively). Subcutaneous fat tissue (SAT) volume was higher in survivors (p = 0.003), and the rate of change in the SAT volume was lower in survivors (p = 0.043). Multivariate logistic regression analysis revealed that a high APACHE II score (OR: 0.834, 95% CI: 0.741–0.938, p = 0.002) and small ESM area (OR: 1.001, 95% CI: 1.000–1.002, p = 0.031) were independent predictors of mortality. In conclusion, the loss of supporting respiratory muscles, particularly ESM, may play a critical role beyond general acute sarcopenia, and the preserved SAT in non-survivors may reflect abnormal glucose metabolism due to severe inflammation. Full article

Background/Objectives: Point-of-care lung ultrasonography (LUS) represents an accurate diagnostic tool in older patients with respiratory failure. The integration of LUS with ultrasonographic assessment of diaphragm thickness and excursion, right vastus lateralis (RVL) muscle thickness and cross-sectional area (CSA) could provide real-time information on frailty and sarcopenia. The primary aim of this proof-of-concept prospective study was to evaluate clinical correlates of thoracic, diaphragmatic, and muscular ultrasound to characterize the associations between frailty, respiratory failure, and sarcopenia in older patients hospitalized for acute respiratory complaints. Methods: Each of 52 participants (age median 84, IQR 80–89 years old) underwent integrated LUS, diaphragm and RVL ultrasound examination upon admission (T0) and after 72 h of hospitalization (T1). LUS score was used to estimate lung interstitial syndrome severity. Diaphragm excursion, thickness, RVL thickness and CSA were measured following a standardized protocol. Frailty was assessed with the PC-FI (Primary Care-Frailty Index). Results: All patients exhibited multifactorial causes of respiratory symptoms. The LUS score on T0 predicted 3-month rehospitalization. Frail patients exhibited higher LUS scores on T1. Diaphragm excursion on T0 was reduced in patients with COPD and heart failure and in those developing delirium during hospitalization. Diaphragm excursion on T1 was negatively associated with PC-FI. Diaphragm thickness, RVL thickness, and CSA exhibited a positive association with obesity. Right vastus lateralis CSA on T1, however, was also negatively associated with PC-FI. Conclusions: Integrated lung, diaphragm, and RVL ultrasound shows clinical correlations with several aspects of frailty that may help to improve the management of geriatric patients with respiratory illness. Full article

Background/Objectives: Despite the effectiveness of exercise and nutritional interventions to improve aerobic capacity and quality of life in lung transplant (LT) recipients, their compliance is low. Strategies to reduce the high attrition rate (participants lost over time) is a major challenge. Artificial neural networks (ANN) may assist in the early identification of patients with high risk of attrition. The main objective of this study is to evaluate the usefulness of ANNs to identify prognostic factors for high attrition rate of a 10-week rehabilitation program after a LT. Methods: This prospective observational study included first-time LT recipients over 18 years of age. The main outcome for each patient was the attrition rate, which was estimated by the amount of missing data accumulated during the study. Clinical variables including malnutrition, sarcopenia, and their individual components were assessed at baseline. An ANN and regression analysis were used to identify the factors determining a high attrition rate. Results: Of the 41 participants, 17 (41.4%) had a high rate of attrition in the rehabilitation program. Only 23 baseline variables had no missing data and were included in the analysis, from which a low age-dependent body mass index (BMI) was the most important conditioning factor for a high attrition rate (p = 7.08 × 10⁻⁵), followed by end-stage respiratory disease requiring PT (p = 0.000111), low health-related quality-of-life (HRQoL) (p = 0.0009078), and low handgrip strength (p = 0.023). Conclusions: The prevalence of high attrition rate in LT recipients is high. The profile of patients with a high probability of attrition includes those with chronic obstructive pulmonary disease, low BMI and handgrip strength, and reduced HRQoL. Full article

The six-minute walking test (6MWT) is an essential test for evaluating exercise tolerance in many respiratory and cardiovascular diseases. Frailty and sarcopenia can cause rapid aging of the cardiovascular system in elderly people. Early detection and evaluation of frailty and sarcopenia are crucial for determining the treatment method. We aimed to develop a wearable measuring system for the 6MWT and propose a method for identifying frailty and quantifying walking muscle strength (WMS). In this study, 60 elderly participants were asked to wear accelerometers behind their left and right ankles during the 6MWT. The gait data were collected by a computer or smartphone. We proposed a method for analyzing walking performance using the stride length (SL) and step cadence (SC) instead of gait speed directly. Four regions (Range I–IV) were divided by cutoff values of SC = 2.0 [step/s] and SL = 0.6 [m/step] for a quick view of the frail state. There were 62.5% of frail individuals distributed in Range III and 72.4% of non-frail individuals in Range I. A concept of a WMS score was proposed for estimating WMS quantitatively. We found that 62.5% of frail individuals were scored as WMS1 and 41.4% of the non-frail elderly as WMS4. The average walking distances corresponding to WMS1–4 were 207 m, 370 m, 432 m, and 462 m, respectively. The WMS score may be a useful tool for quantitatively estimating sarcopenia or frailty due to reduced cardiopulmonary function. Full article

Recent studies indicate a significant relationship between malnutrition, frailty, and pleural effusion (PE), highlighting the critical role of muscle mass in patient outcomes. This review investigates the association between sarcopenia—characterized by a decline in skeletal muscle mass and function—and PE, marked by fluid accumulation in the pleural space. The findings reveal that sarcopenia is prevalent in patients with PE and is linked to increased postoperative complications and mortality rates. In liver transplantation, esophagectomy, and lung cancer surgeries, sarcopenia exacerbates the risk of adverse outcomes. Notably, preoperative muscle mass assessment serves as a predictive tool for identifying patients at higher risk of complications. This review underscores the importance of early diagnosis and intervention for sarcopenia to improve clinical outcomes in PE patients. The therapeutic approach should include comprehensive nutritional evaluations and targeted muscle-strengthening interventions. By addressing sarcopenia, healthcare providers can significantly reduce PE-related complications, enhance patient recovery, and improve survival rates. This review provides a foundation for future research to develop effective strategies for the management and treatment of sarcopenia in the context of PEs, aiming to optimize patient care and quality of life. Full article

Background: Older adults have a high risk for musculoskeletal, cardiorespiratory, and mental health problems. We compared respiratory muscle strength, cardiovascular endurance, physical activity (PA), and depression between older adults with and without sarcopenia. Methods: This matched case–control study included 200 Thai older adults (100 participants with and without sarcopenia). According to the Asian Working Group for Sarcopenia 2019, participants completed a handgrip dynamometer, a 6 m walk test, and bioimpedance analysis for sarcopenia screening. Individuals were required to evaluate their cardiovascular endurance and respiratory muscle strength and complete a set of questionnaires (i.e., depression and PA). Participants with and without sarcopenia were compared using a t-test, and ANOVA was used for subgroup analysis. Results: Participants with sarcopenia had significantly lower inspiratory muscle strength (p < 0.001), functional capacity (p = 0.032), PA (p < 0.001), and higher depression scores (p < 0.001) than those without sarcopenia. Respiratory muscle strength and PA were significantly reduced in those with severe sarcopenia, followed by those with sarcopenia, possible sarcopenia, and no sarcopenia. Older adults with severe sarcopenia had higher depression scores than those with sarcopenia, possible sarcopenia, or no sarcopenia. Conclusions: Older adults with sarcopenia may exhibit lower cardiorespiratory performance, less PA, and higher depression than those without sarcopenia. Full article

Diaphragm muscle dysfunction is increasingly recognized as a fundamental marker of several age-related diseases and conditions including chronic obstructive pulmonary disease, heart failure and critical illness with respiratory failure. In older individuals with physical frailty and sarcopenia, the loss of muscle mass and function may also involve the diaphragm, contributing to respiratory dysfunction. Ultrasound has recently emerged as a feasible and reliable strategy to visualize diaphragm structure and function. In particular, it can help to predict the timing of extubation in patients undergoing mechanical ventilation in intensive care units (ICUs). Ultrasonographic evaluation of diaphragmatic function is relatively cheap, safe and quick and can provide useful information for real-time monitoring of respiratory function. In this review, we aim to present the current state of scientific evidence on the usefulness of ultrasound in the assessment of diaphragm dysfunction in different clinical settings, with a particular focus on older patients. We highlight the importance of the qualitative information gathered by ultrasound to assess the integrity, excursion, thickness and thickening of the diaphragm. The implementation of bedside diaphragm ultrasound could be useful for improving the quality and appropriateness of care, especially in older subjects with sarcopenia who experience acute respiratory failure, not only in the ICU setting. Full article

COVID-19 can manifest as either asymptomatic or progressing to a severe phase in some patients, which may require hospitalization. These patients may experience dyspnea and hypoxia, leading to the development of acute respiratory distress syndrome. Studies have reported an increased risk of severe sarcopenia in COVID-19 patients during and after recovery. This narrative review aimed to summarize and synthesize available studies on the association between sarcopenia and mortality in critically ill COVID-19 patients. A total of 22 studies conducted on hospitalized COVID-19 patients were included in this review. Of those, 17 studies reported a direct association, while 5 studies showed no association between sarcopenia and mortality in severe COVID-19 patients. It is important to maintain muscle quality and quantity in defense against COVID-19. The measurement of lean muscle mass should be included in the risk assessment of severely ill COVID-19 patients as part of the therapy plan. Full article

Muscle weakness and muscle loss characterize many physio-pathological conditions, including sarcopenia and many forms of muscular dystrophy, which are often also associated with mitochondrial dysfunction. Verbascoside, a phenylethanoid glycoside of plant origin, also named acteoside, has shown strong antioxidant and anti-fatigue activity in different animal models, but the molecular mechanisms underlying these effects are not completely understood. This study aimed to investigate the influence of verbascoside on mitochondrial function and its protective role against H₂O₂-induced oxidative damage in murine C2C12 myoblasts and myotubes pre-treated with verbascoside for 24 h and exposed to H₂O₂. We examined the effects of verbascoside on cell viability, intracellular reactive oxygen species (ROS) production and mitochondrial function through high-resolution respirometry. Moreover, we verified whether verbascoside was able to stimulate nuclear factor erythroid 2-related factor (Nrf2) activity through Western blotting and confocal fluorescence microscopy, and to modulate the transcription of its target genes, such as heme oxygenase-1 (HO-1) and peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α), by Real Time PCR. We found that verbascoside (1) improved mitochondrial function by increasing mitochondrial spare respiratory capacity; (2) mitigated the decrease in cell viability induced by H₂O₂ and reduced ROS levels; (3) promoted the phosphorylation of Nrf2 and its nuclear translocation; (4) increased the transcription levels of HO-1 and, in myoblasts but not in myotubes, those of PGC-1α. These findings contribute to explaining verbascoside’s ability to relieve muscular fatigue and could have positive repercussions for the development of therapies aimed at counteracting muscle weakness and mitochondrial dysfunction. Full article