George Masil, Azhar Gohar, Pangle Amanda, Peeler Eric, Dawson Amanda, Coker Robert, Coleman Kellie S, Schrader Amy, Wei Jeanne
Department of Geriatrics, Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
J Physiother Phys Rehabil. 2017;2(2). doi: 10.4172/2573-0312.1000137. Epub 2017 Apr 24.
Cardiac cachexia is a condition associated with heart failure, particularly in the elderly, and is characterized by loss of muscle mass with or without the loss of fat mass. Approximately 15% of elderly heart failure patients will eventually develop cardiac cachexia; such a diagnosis is closely associated with high morbidity and increased mortality. While the mechanism(s) involved in the progression of cardiac cachexia is incompletely established, certain factors appear to be contributory. Dietary deficiencies, impaired bowel perfusion, and metabolic dysfunction all contribute to reduced muscle mass, increased muscle wasting, increased protein degradation, and reduced protein synthesis. Thus slowing or preventing the progression of cardiac cachexia relies heavily on dietary and exercise-based interventions in addition to standard heart failure treatments and medications.
The aim of the present study was to test the feasibility of an at-home exercise and nutrition intervention program in a population of elderly with heart failure, in an effort to determine whether dietary protein supplementation and increased physical activity may slow the progression, or prevent the onset, of cardiac cachexia. Frail elderly patients over the age of 55 with symptoms of heart failure from UAMS were enrolled in one of two groups, intervention or control. To assess the effect of protein supplementation and exercise on the development of cardiac cachexia, data on various measures of muscle quality, cardiovascular health, mental status, and quality of life were collected and analyzed from the two groups at the beginning and end of the study period.
More than 50% of those who were initially enrolled actually completed the 6-month study. While both groups showed some improvement in their study measures, the protein and exercise group showed a greater tendency to improve than the control group by the end of the six months.
These findings suggest that with a larger cohort, this intervention may show significant positive effects for elderly patients who are at risk of developing cardiac cachexia.
心脏恶病质是一种与心力衰竭相关的病症，在老年人中尤为常见，其特征是肌肉量减少，可能伴有或不伴有脂肪量减少。约15%的老年心力衰竭患者最终会发展为心脏恶病质；这种诊断与高发病率和死亡率密切相关。虽然心脏恶病质进展所涉及的机制尚未完全明确，但某些因素似乎起到了作用。饮食不足、肠道灌注受损和代谢功能障碍都会导致肌肉量减少、肌肉消耗增加、蛋白质降解增加以及蛋白质合成减少。因此，除了标准的心力衰竭治疗和药物外，减缓或预防心脏恶病质的进展在很大程度上依赖于基于饮食和运动的干预措施。
本研究的目的是测试一项针对老年心力衰竭患者的家庭运动和营养干预计划的可行性，以确定补充膳食蛋白质和增加身体活动是否可以减缓心脏恶病质的进展或预防其发生。来自阿肯色大学医学科学分校的55岁以上有心力衰竭症状的体弱老年患者被纳入干预组或对照组。为了评估补充蛋白质和运动对心脏恶病质发展的影响，在研究期开始和结束时从两组收集并分析了关于肌肉质量、心血管健康、精神状态和生活质量等各项指标的数据。
最初参与研究的人中超过50%实际完成了为期6个月的研究。虽然两组在研究指标上都有一定改善，但到六个月结束时，蛋白质和运动组比对照组显示出更大的改善趋势。
这些发现表明，对于更大规模的队列研究，这种干预措施可能对有发展为心脏恶病质风险的老年患者显示出显著的积极效果。
