Department of Geriatric Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore.
Society for Geriatric Medicine Singapore, Singapore, Singapore.
BMC Geriatr. 2021 May 17;21(1):314. doi: 10.1186/s12877-021-02240-8.
The rapidly aging societies worldwide and in Singapore present a unique challenge, requiring an integrated multidisciplinary approach to address high-value targets such as muscle health. We propose pragmatic evidence-based multidisciplinary consensus recommendations for the assessment and multi-modal management of muscle health in older adults (≥65 years) across the continuum of care.
The recommendations are derived from an in-depth review of published literature by a multidisciplinary working group with clinical experience in the care of the older population in both acute and community settings.
The panel recommends screening for muscle impairment using the SARC-F questionnaire, followed by assessment for low muscle strength (handgrip strength or 5-times chair stand test ≥10 s as a surrogate for lower limb strength) to diagnose possible/probable sarcopenia. For uncomplicated cases, lifestyle modifications in exercise and diet can be initiated in the community setting without further assessment. Where indicated, individuals diagnosed with possible/probable sarcopenia should undergo further assessment. Diagnosis of sarcopenia should be based on low muscle strength and low muscle mass (bioimpedance analysis, dual-energy X-ray absorptiometry or calf circumference as a surrogate). The severity of sarcopenia should be determined by assessment of physical performance (gait speed or 5-times chair stand test ≥12 s as a surrogate for gait speed). To treat sarcopenia, we recommend a combination of progressive resistance-based exercise training and optimization of nutritional intake (energy, protein and functional ingredients). High quality protein in sufficient quantity, to overcome anabolic resistance in older adults, and distributed throughout the day to enable maximum muscle protein synthesis, is essential. The addition of resistance-based exercise training is synergistic in improving the sensitivity of muscle protein synthesis response to the provision of amino acids and reducing anabolic resistance. An expected dose-response relationship between the intensity of resistance-based training, lean mass and muscle strength is described.
Reviewed and endorsed by the Society of Rehabilitation Medicine Singapore and the Singapore Nutrition and Dietetics Association, these multidisciplinary consensus recommendations can provide guidance in the formulation of comprehensive and pragmatic management plans to improve muscle health in older adults in Singapore and Asia.
全球和新加坡的老龄化社会带来了独特的挑战，需要采取综合多学科方法来解决肌肉健康等高价值目标。我们针对医疗保健各个环节的老年人群（≥65 岁）提出了实用的基于证据的多学科肌肉健康评估和多模式管理共识建议。
这些建议源自一个多学科工作组对已发表文献的深入审查，该工作组在急性和社区环境中都具有照顾老年人群的临床经验。
专家组建议使用 SARC-F 问卷筛查肌肉功能障碍，然后评估低肌肉力量（握力或 5 次起坐测试≥10 秒作为下肢力量的替代指标），以诊断可能/疑似肌少症。对于简单病例，可以在社区环境中启动生活方式调整（运动和饮食），而无需进一步评估。在有指征的情况下，应进一步评估诊断为可能/疑似肌少症的个体。肌少症的诊断应基于低肌肉力量和低肌肉量（生物电阻抗分析、双能 X 射线吸收法或小腿围度作为替代指标）。通过评估身体机能（步速或 5 次起坐测试≥12 秒作为步速的替代指标）确定肌少症的严重程度。为治疗肌少症，我们建议采用渐进式抗阻训练和优化营养摄入（能量、蛋白质和功能性成分）相结合的方法。为克服老年人的合成代谢抵抗并使肌肉蛋白合成最大化，高质量、足够数量的蛋白质至关重要。增加抗阻训练具有协同作用，可以提高肌肉蛋白合成对氨基酸供应的敏感性并降低合成代谢抵抗。描述了抗阻训练强度、瘦体重和肌肉力量之间的预期剂量反应关系。
这些多学科共识建议经过新加坡康复医学学会和新加坡营养与饮食协会的审查和认可，可以为制定全面实用的管理计划提供指导，以改善新加坡和亚洲老年人的肌肉健康。
