Resistance training benefits patients with sarcopenia

Relation

Chen N, He X, Feng Y, Feng Y, Ainsworth BE, Liu Y. Effects of resistance training in healthy elderly people with sarcopenia: a systematic review and meta-analysis of randomized controlled trails.Eur Rev Aging Physics Law. 2021;18(1):23.

Study objective

To analyze the existing evidence for resistance training on muscle strength, muscle performance and body composition in healthy older people with sarcopenia at baseline

Draft

A meta-analysis of randomized controlled trials (RCTs)

Participant

Participants included 561 adults (aged >60 years) with sarcopenia in 14 RCTs published between January 2010 and October 2020. All studies included at least 1 type of resistance exercise, with 292 (52%) participants receiving more than 1 mode of resistance training. Seven RCTs included both genders, 6 included only women, and 1 had no gender listed.

Exclusion criteria included previous illnesses (e.g. cancer, chronic obstructive pulmonary disease). [COPD]diabetes, osteoporosis), articles that were not in English or Chinese, articles without a control group, and those that did not include all outcome measures (below).

Study parameters assessed

The following endpoints were required for inclusion in this meta-analysis:

• Körperzusammensetzung (Skelettmuskelmasse [SMM]Bein magere Muskelmasse [LMM]appendikulärer Skelettmuskelindex (ASMI) und Körperfettmasse [BFM])
• Muskelkraft (Kniestreckerkraft [KES] und Griffstärke [HGS])
• Muskelleistung (Ganggeschwindigkeit [GS] und terminiert und los [TUG])

Investigators assessed different resistance training exercises and body measurements depending on the RCT. The studies also varied in which body parts they assessed and under what parameters.

Each RCT had a level of intensity applied to each exercise and a number of repetitions, resulting in a wide-ranging meta-analysis. The researchers evaluated the following 3 body metrics to simplify the study design and conducted a subgroup analysis of these 3 groups, specifically focusing on the factors of age, gender, sarcopenia diagnostic criteria, obesity, intervention duration, frequency, manner and intensity.

Body composition

Eleven of the RCTs assessed body composition based on 2 main parameters: muscle mass and body fat mass (BFM). Muscle mass was divided into 3 separate groups: skeletal muscle mass (SMM), leg muscle mass (LMM), and appendicular skeletal muscle index (ASMI).

Muscle strength

Thirteen of the RCTs examined resistance training on muscle strength specifically for handgrip strength (HGS) and knee extensor strength (KES).

Muscle performance

Six of the studies measured grip strength (GS) and Timed Up and Go (TUG), a test commonly used to assess mobility, walking ability, balance and fall risk in older adults.¹

Key insights

Regarding body composition, when comparing resistance training with the control group, no significant differences were found in the following parameters: SMM alone (P=0.07, I2=0%), LLM alone (P=0.52, I2=0%) and ASMI alone (P=0.35, I2=68%). However, significant decreases were found when comparing BFM in both strength training groups compared to the control group (P=0.0002, I2=0%).

Muscle mass increased significantly in populations aged >70 years (P=0.0002), female (P=0.02), met the diagnostic criteria of the Asian Working Group Sarcopenia (AWGS) (P<0.0001) and were of normal weight (P=0.004). Greater increases in muscle mass were also observed when resistance training was performed more than three times per week (P=0.007), ≥12 weeks (P=0.008) and with at least 60% 1-rep maximum (1RM) intensity (P=0.003).

In the category Muscle Strength, HGS (P=0.0005, I2=81%) and KES (P<0.0001, I2=67%) were significantly increased in the resistance training group. However, there was a more significant increase in HGS in the group over 70 years (P<0.0001) and modest significant increases in women (P=0.005), with AWGS sarcopenia diagnostic criteria (P<0.0001) and obese (P=0.01) populations. If participants completed resistance training less than three times per week (P=0.04) or ≥3 times per week (P=0.02) and with a total duration >12 weeks (P=0.04) or ≤12 weeks (P=0.03), significant increases in HGS were also observed. HGS had a greater effect when performed as constant resistance exercise training (P=0.0007) and with >60% 1-rep maximum intensity (P<0.0001).

KES, on the other hand, was significantly increased regardless of the subject characteristics: age >70 years (P<0.0001), ≤70 (P<0.0001), female (P<0.0001), male (P<0.0001), those with other sarcopenia diagnostic criteria (P<0.0001) and people with obesity (P<0.0001).

For muscle performance, GS increased significantly in the resistance training group (P=0.006, I2=89%) and the TUG time was significantly shortened (P< 0.0001, I2 = 23%).

transparency

This meta-analysis was funded by a special health research project of the Shanghai Municipal Health Commission on the Health of Aging, Woman and Children. No conflicts of interest of the author were disclosed.

Practice implications

Sarcopenia is a decline in skeletal muscle mass and function and is known to result in frailty, cachexia, osteoporosis, metabolic syndromes, and ultimately, early death.²Approximately 25% to 45% of older adults, even when healthy, are diagnosed with sarcopenia, which often has a devastating impact on the medical system.³From a public health perspective, the total annual cost of hospitalizations for patients with sarcopenia in the United States is $40.4 billion, an average annual cost of $260 per person.⁴Older age, female gender, lower education, lower socioeconomic status, being underweight, and lower birth weight are all associated with a higher likelihood of sarcopenia.⁵

Various therapies have been evaluated for the treatment of sarcopenia, although exercise appears to outperform all others.⁶Specialized and easily reproducible exercise programs improve multiple health markers for sarcopenia patients, resulting in improved longevity and quality of life. According to the authors of the study reviewed here, this publication is the first systematic review and meta-analysis aimed at evaluating the effect of resistance training on older people with sarcopenia. They discovered that several body metrics improved significantly with different forms of resistance training exercises.

However, they did not evaluate the effects of supplements or diets on sarcopenia, which research suggests may also provide additional benefit. Leucine, creatinine, and other high-value amino-based metabolites appear to enhance the beneficial aspects of resistance training in the same elderly patients.⁷So while resistance training shows clear value, additional research is needed into a combination of therapies for the most comprehensive approach