Department of Physical Therapy-Federal University of Jequitinhonha and Mucuri Valleys, Diamantina, Minas Gerais, Brazil.
Division of General Internal and Geriatric Medicine, School of Medicine-Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil.
J Geriatr Phys Ther. 2019 Jul/Sep;42(3):E135-E141. doi: 10.1519/JPT.0000000000000138.
Frailty is a common and important geriatric syndrome, distinct from any single chronic disease, and an independent predictor of mortality. It is characterized by age-associated decline in physiological reserve and function across multiple systems, culminating in a vicious cycle of altered energy expenditure. The total energy expenditure (TEE) of an individual includes the resting metabolic rate (RMR), the thermic effect of feeding, and the energy expenditure in physical activity (PAEE). The investigation of the energy expenditure of older adults who are frail is essential for better understanding the syndrome. Therefore, we compared the RMR, the PAEE, the physical activity level (PAL), and the TEE of older adults who were frail with those who were not frail.
A cross-sectional study was conducted with 26 community-dwelling older adults (66-86 years of age). Older adults in the frail and nonfrail groups were matched for age and gender, and the matched pairs were randomly selected to continue the study. The RMR was measured by indirect calorimetry. The TEE was obtained by the multipoint, doubly labeled water method. After collecting a baseline urine sample, each participant received an oral dose of doubly labeled water composed of deuterium oxide and oxygen-18 (H2O). Subsequently, urine samples were collected on the 1st, 2nd, 3rd, 7th, 12th, 13th, and 14th days after the baseline collection and analyzed by mass spectrometry.
The older adults who were frail presented significantly lower PAEE (1453.7 [1561.9] vs 3336.1 [1829.3] kj/d, P < .01), PAL (1.4 [0.3] vs 1.9 [0.6], P = .04), and TEE (7919.0 [2151.9] vs 10442.4 [2148.0] kj/d, P < .01) than the older adults who were nonfrail. There was no difference in their RMRs (5673.3 [1569.2] vs 6062.0 [1891.7] kj/d, P = .57). Frailty has been associated with a smaller lean body mass and with a disease-related hypermetabolic state, which might explain the lack of difference in the RMR. The PAL of the older adults who were frail was below the recommended level for older adults and determined a lower PAEE and TEE when compared with older adults who were not frail.
This study showed that low energy expenditure in physical activity is a main component of frailty. The PAL of the older adults who were frail was far below the recommended level for older adults.
衰弱是一种常见且重要的老年综合征，与任何单一的慢性疾病都不同，是死亡的独立预测因素。它的特征是与年龄相关的多个系统生理储备和功能下降，最终导致能量消耗的恶性循环。个体的总能量消耗（TEE）包括静息代谢率（RMR）、进食的热效应和体力活动能量消耗（PAEE）。研究衰弱老年人的能量消耗对于更好地了解该综合征至关重要。因此，我们比较了衰弱和非衰弱老年人的 RMR、PAEE、身体活动水平（PAL）和 TEE。
采用横断面研究，纳入 26 名社区居住的老年人（66-86 岁）。衰弱组和非衰弱组老年人按年龄和性别匹配，随机选择匹配对继续研究。RMR 通过间接热量法测量。TEE 通过多点、双标记水法获得。收集基线尿液样本后，每位参与者口服由重水和氧-18（H2O）组成的双标记水。随后，在基线采集后的第 1、2、3、7、12、13 和 14 天收集尿液样本，并通过质谱分析。
与非衰弱老年人相比，衰弱老年人的 PAEE（1453.7[1561.9] vs 3336.1[1829.3] kj/d，P<.01）、PAL（1.4[0.3] vs 1.9[0.6]，P=.04）和 TEE（7919.0[2151.9] vs 10442.4[2148.0] kj/d，P<.01）明显较低。两组老年人的 RMR 无差异（5673.3[1569.2] vs 6062.0[1891.7] kj/d，P=.57）。衰弱与瘦体质量较小和与疾病相关的高代谢状态有关，这可能解释了 RMR 无差异。与非衰弱老年人相比，衰弱老年人的 PAL 低于老年人的推荐水平，导致 PAEE 和 TEE 较低。
本研究表明，体力活动中的低能量消耗是衰弱的主要组成部分。衰弱老年人的 PAL 远低于老年人的推荐水平。
Zotero 插件