Revalidatie van spieratrofie & spierzwakte

Revalidatie van spieratrofie & spierzwakte

Ivan Bautmans

Frailty in Ageing research groupwww.vub.ac.be/FRIA

Sarcopenia Rosenberg J Nutr 1997

Age-related loss of muscle mass

Roubenoff R. J Gerontol 2003

25 yrs 75 yrs

Muscle weakness; Physical fatigue; Loss of flexibility

Bauer & Sieber Exp Gerontol 2008; 43: 674-678

Neuroendocrinedysregulation

Acute inflammation• Rapid worsening of sarcopenia• Hospitalized geriatric patients with

acute infections / after elective surgery– Worse muscle performance ~ Inflammation– Reduced recovery of muscle endurance

Bautmans ea. AgeingClin&ExpRes 2005; Mets ea. AmJGeriatrPharmacother 2004; Bautmans ea. JGerontol 2005; Bautmans ea. BMC Geriatrics 2007; Bautmans ea. JAmGeriatrSoc 2008; Bautmans ea. JGerontol 2010; Bautmans ea. JNutrHealth&Ageing 2011; Beyer ea. ExpGerontol 2011; Bautmans ea. Gait & Posture 2011; Beyer ea. BMC Musculoskeletal 2011

Bautmans ea. J Gerontology 2010

Inflammatory response following surgery

N=66, age 24-91 yrs, elective abdominal surgery

Saini ea. Ageing Research Reviews 2009;8:251–267

InflammationExercise ↑ ↑

Adapted from Williams ea Circulation 2007

70-80% Max resistance

N=31, Age=60-80 yrsBautmans ea. Gerontology 2005; 51: 253-65

Peterson ea. Ageing Research Reviews 2010;9:226–237

15kg 60kg

N=56, aged 68±5yrs

Van Roie ea. Exp Gerontol 2013; 48: 1351-61

HIGH = 2x 10–15 rep @ 80% 1RM

LOW = 1× 80–100 rep @ 20% 1RM

LOW+ = 1× 60 rep @ 20% 1RM + 1× 10–20 rep @ 40% 1RM

• Inefficient Akt/mTOR signaling pathway• Preference for endurance exercise?• Inflammation-reducing effect of exercise.

• N=106, age 53–83 yrs, randomly assigned to– 1yr 3x/wk strength training (60-80% 1RM)

+ impact exercise (jumping)– 1yr 3x/wk stretching

• Training:– ↑muscle strength– functional benefit observed in both groups

• N=20, 75± 7 yrs• Fatigue & weakness• 12wk training,

±20min 3x/wk• Results:

– No pain– ↑knee strength– ↓TUG

• N=57, age 70±7 yrs, randomly assigned to– 12 wks 2x/wk resistance (2-4 stets @ 6RM)

+ aerobic exercise (20min @ 80% HRmax)

– 12 wks usual care

• Exercise:– ↑lean mass, ↑ muscle strength, ↑ walk speed, ↑QoL,

– ↓fatigue, ↓CRP

Beyer ea Current Opinion in Clinical Nutrition and Metabolic Care 2012; 15: 12-22

Pedersen & Febbraio Physiol Rev 2008; 88: 1379–1406

“myokine” pathway

Pro-inflammatory Anti-inflammatory Anti-inflammatory

= reduction of chronic low-grade inflammatory profile

N=31, Age=60-80 yrsBautmans ea. Gerontology 2005; 51: 253-65

Acute exercise-induced response

Chronic effectsN=31, age=60-80 yrs

Bautmans ea. Gerontology 2005; 51: 253-65

8wk training 3x/wk

RT & RTTB ↑intra-muscular IL-6 levels!

Strength training in older cancer patients

• Literature is rather scarce• Positive effects can be obtained!

– Muscle performance– inflammation

• Dose-response relationships remain unclear

• Potential interfering factors– Inflammation / cachexia– Chemo/radio therapy or ‘survivor’– Hormonal treatment

http://www.vub.ac.be/FRIA/SPRINT.html

Thank you. ibautman@vub.ac.be