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Various Exercise Interventions Improve Sarcopenia in Older Adults at Risk for Osteoporotic Fractures

Meredith Edwards Trust

May 2015

Sarcopenia, the age-related loss of muscle mass and strength, is common among individuals with osteoporosis.

“Our group from the National Taiwan University Hospital and Chang-Gung Memorial Hospital has been conducting research on [a] community program for osteoporosis/fracture screening and education since 2013,” lead author Ding-Cheng Chan, MD, PhD, FACP, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan, told Annals of Long-Term Care: Clinical Care and Aging in an e-mail. “In 2014, our research question was whether three different types of interventions may have different effects on sarcopenic indices among high-risk groups.”

The results of the group’s study were presented in a poster abstract at the recent World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases in Milan, Italy (March 26–29, 2015).

All study participants were community-dwelling individuals (mean age, 72.3 years) who were deemed to be at high fall and osteoporotic fracture risk as determined by standardized questionnaires or the Fracture Risk Assessment Tool (FRAX). Over 72% of participants were women.

Fifty-five patients from the National Taiwan University Hospital Bei-Hu Branch were randomized into both the integrated care group (ICG) and the lower-extremity exercise group (LEEG). Forty-one patients from the Lingko Chang Gung Memorial Hospital were assigned to the home exercise group (HEG). Both hospitals are located in Taiwan.

Researchers provided the patients with a CD-ROM and a two-hour instructional session with a home/community exercise program prior to the beginning of the study.

Individuals in the HEG were instructed to perform the designed exercise three times per week, those in the ICG participated in once-weekly group exercises from the CD-ROM, and those in the LEEG participated in twice-weekly machine-based lower-extremity exercises at the hospital.
The major outcomes of the study were muscle mass, grip strength, walking speed, and lower leg extension power measured at baseline and after 12-weeks of intervention. Muscle mass was measured by bioelectrical-impedance analysis.

“Our hypothesis was that subjects in the ICG (hospital-based exercise and counseling program) and LEEG would have better improvements on sarcopenic indices than those in the HEG,” said Chan.
At baseline, researchers recorded the mean appendicular skeletal muscle index (ASMI) at 7.3±1.1 kg/m2, the mean hand grip strength at 17.3±8.2 kg, the mean walking speed at 1.2±0.3 m/s, and the mean leg extension power at 21.7±4.8 kg.

At the end of 12 weeks, significant improvements were detected in handgrip strength, walking speed, and leg extension power (18.8±6.8 kg, 1.3±0.3 m/s, and 27.1±5.9 kg, respectively; all paired t-tests; P<.001). These improvements were similar among all three groups.

The ASMI stayed the same at 7.3±1.1 kg/m2.

“All three types of interventions are equally effective in improving grip strength, walking speed, [and] lower extension power in 3 months among high osteoporotic fracture or fall-risk older adults,” Chan said. He noted that these results were somewhat unexpected based on their hypothesis.

“We felt that bone and muscle health are both important to keep patients away from fall and subsequent osteoporotic fractures,” he continued. “Our results add to the literature that different types of interventions can all improve sarcopenia among high-fracture or fall-risk patients and may prevent their falls in the long-run.”

This study was sponsored by the Wang Jhan-Yang Charitable Trust Fund.

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