Akehurst, Ewelina (2019) Associations of Sarcopenia Components with Physical Function, Health-Related Quality of Life and Nutrition in Older Adults Performing Exercise Training. Research Master thesis, Victoria University.

Abstract

Background: Sarcopenia is an ageing-related muscle disease that can be prevented and treated with exercise, particularly resistance training. The purpose of this project was to explore prevalence of sarcopenia and its associations with physical function, physical activity, health-related quality of life (HRQoL) and nutrition in Australian older adults participating in exercise programs at four gyms operated by Uniting AgeWell, Melbourne. It also examines associations with HRQoL in older adults in the United States (US) participating in exercise programs at the University of Texas at El Paso. Methods: A total of 105 older Australian community-dwelling adults (mean ± SD 76.9 ± 6.2 years), who were already undergoing resistance training, and 85 US community-dwelling adults (mean ± SD 67.7 ± 6.8 years) were assessed for sarcopenia components. The Melbourne analysis included appendicular lean mass (ALM) (assessed using dual energy X-ray absorptiometry; DEXA), muscle strength (assessed by handgrip strength and chair stands) and physical performance (assessed by gait speed, short physical performance battery [SPPB], timed up and go [TUG] and 400-metre walk [400mW] tests). Spearman correlations explored associations for sarcopenia components with self-reported function (via SARC-F), HRQoL (via Assessment of Quality of Life [AQoL-4D], physical activity (via Physical Activity Scale for Elderly [PASE]), and nutrition (via Australian Eating Survey [AES]). The US analysis of historical (2016) data also included DEXA’s ALM, muscle strength (assessed by handgrip strength) and physical performance (assessed by gait speed and TUG) and HRQoL (assessed by AQoL-4D) to match the Melbourne study. Results: Sarcopenia prevalence in the Melbourne cohort was 3.8% according to Foundation for the National Institutes of Health (FNIH) sarcopenia project and the revised European Working Group on Sarcopenia in Older People (EWGSOP2) definitions, and 10.5% according to EWGSOP1. Slower chair stand times were associated with poorer HRQoL (p = 0.043), as were TUG and 400mW (p < 0.01). Slower TUG and 400mW were also associated with lower physical activity (p = 0.018 and p = 0.035, respectively). Positive associations were observed for gait speed with HRQoL (p = 0.001) and PASE (p = 0.048), handgrip strength with PASE (p = 0.032), ALM/BMI with PASE (p = 0.030) and ALM (p < 0.05) and ALM/BMI (p < 0.01) with protein and energy intake. Australian Recommended Food Score (ARFS) was not associated with any of the sarcopenia components. Sarcopenia was only detected by the FNIH definition in the US sample (7.1%) and no significant associations were observed for sarcopenia components with HRQoL before and after the exercise intervention (all p > 0.05). Conclusion: Sarcopenia prevalence in older adults participating in supervised exercise programs was low and varied according to the definition applied. A universally accepted definition of sarcopenia is recommended to enable consistent diagnosis and implementation in clinical settings. Due to low prevalence of sarcopenia at baseline in the El Paso cohort, it has not significantly changed by exercise, however significant changes were observed in sarcopenia components. Strength training significantly contributed to muscle strength, mass, function, and HRQoL. Power/agility training only to muscle strength and function. It can be concluded that exercises, particularly ST, can improve sarcopenia components and HRQoL in community-dwelling older adults. Sarcopenia components have inconsistent associations with poorer HRQoL in community-dwelling older adults, perhaps indicating that the effects of sarcopenia on HRQoL are most pronounced in older age. Ensuring maintenance of adequate nutrition and non-supervised physical activity may enhance the benefits of supervised training for older adults.

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