The impact of disease-related immobilization on thigh muscle mass and strength in frail older hospitalized patients

Abstract Background We assessed the quantitative changes in muscle mass and strength during 2 weeks of hospitalization in immobile and mobile acutely ill hospitalized older adults. Methods Forty-one patients (82.4 ± 6.6 years, 73.0% females) participated in this prospective longitudinal observational study. Mobility status was defined according to walking ability as described in the Barthel-Index. Functional status, including handgrip strength and isometric knee-extension strength, and mid-thigh magnetic resonance imaging (MRI) measurements of cross-sectional area (CSA) were conducted on admission and at discharge. Results Twenty-two participants (54%) were immobile and 19 (46%) mobile. In all, 54.0 and 12.0% were at risk of malnutrition and malnourished, respectively. The median time between baseline and follow-up for MRI scans were 13 days in mobile and immobile participants (P = 0.072). Mid-thigh muscle and subcutaneous fat CSA significantly decreased by 3.9cm2 (5.0%, P = 0.002) and 5.3cm2 (5.7%, P = 0.036) during hospitalization whereas intermuscular fat remained unchanged in immobile subjects. No significant changes were observed in mobile patients. In a regression analysis, mobility was the major independent risk factor for changes in mid-thigh muscle CSA as a percentage of initial muscle area (P = 0.022) whereas other variables such as age (P = 0.584), BMI (P = 0.879), nutritional status (P = 0.835) and inflammation (P = 0.291) were not associated with muscle mass changes. There was a significant decrease in isometric knee extension strength (P = 0.002) and no change in handgrip strength (P = 0.167) in immobile patients whereas both parameters increased significantly over time in mobile patients (P = 0.048 and P = 0.012, respectively). Conclusions Two weeks of disease-related immobilization result in a significant loss of thigh muscle mass and muscle strength in older patients with impaired mobility. Concomitantly, there was a significant reduction of subcutaneous adipose tissue in immobile older hospitalized patients whereas no changes were observed in intermuscular fat among these patients. These data highlight the importance of mobility support in maintaining muscle mass and function in older hospitalized patients.

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The impact of disease-related immobilization on thigh muscle mass and strength in frail older hospitalized patients

10.21203/rs.3.rs-27443/v4 ◽

2020 ◽

Author(s):

Nikola Rommersbach ◽

Rainer Wirth ◽

Gero Lueg ◽

Christiane Klimek ◽

Mirja Schnatmann ◽

...

Keyword(s):

Muscle Mass ◽

Handgrip Strength ◽

Knee Extension ◽

Hospitalized Patients ◽

Thigh Muscle ◽

Knee Extension Strength ◽

Isometric Knee Extension ◽

Intermuscular Fat ◽

Prospective Longitudinal ◽

The Impact

Abstract Background: We assessed the quantitative changes in muscle mass and strength during two weeks of hospitalization in immobile and mobile acutely ill hospitalized older adults.Methods: 41 patients (82.4±6.6 years, 73.0% females) participated in this prospective longitudinal observational study. Mobility status was defined according to walking ability as described in the Barthel-Index. Functional status, including handgrip strength and isometric knee-extension strength, and mid-thigh magnetic resonance imaging (MRI) measurements of cross-sectional area (CSA) were conducted on admission and at discharge. Results: Twenty-two participants (54%) were immobile and 19 (46%) mobile. In all, 54.0% and 12.0% were at risk of malnutrition and malnourished, respectively. The median time between baseline and follow-up for MRI scans were 13 days in mobile and immobile participants (P=0.072). Mid-thigh muscle and subcutaneous fat CSA significantly decreased by 3.9cm2 (5.0%, P=0.002) and 5.3cm2 (5.7%, P=0.036) during hospitalization whereas intermuscular fat remained unchanged in immobile subjects. No significant changes were observed in mobile patients. In a regression analysis, mobility was the major independent risk factor for changes in mid-thigh muscle CSA as a percentage of initial muscle area (P=0.022) whereas other variables such as age (P=0.584), BMI (P= 0.879), nutritional status (P=0.835) and inflammation (P=0.291) were not associated with muscle mass changes. There was a significant decrease in isometric knee extension strength (P=0.002) and no change in handgrip strength (P=0.167) in immobile patients whereas both parameters increased significantly over time in mobile patients (P=0.048 and P=0.012, respectively).Conclusions: Two weeks of disease-related immobilization result in a significant loss of thigh muscle mass and muscle strength in older patients with impaired mobility. Concomitantly, there was a significant reduction of subcutaneous adipose tissue in immobile older hospitalized patients whereas no changes were observed in intermuscular fat among these patients. These data highlight the importance of mobility support in maintaining muscle mass and function in older hospitalized patients.

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The impact of disease-related immobilization on thigh muscle mass and strength in frail older hospitalized patients

10.21203/rs.3.rs-27443/v2 ◽

2020 ◽

Author(s):

Nikola Rommersbach ◽

Rainer Wirth ◽

Gero Lueg ◽

Christiane Klimek ◽

Mirja Schnatmann ◽

...

Keyword(s):

Muscle Mass ◽

Handgrip Strength ◽

Knee Extension ◽

Hospitalized Patients ◽

Thigh Muscle ◽

Knee Extension Strength ◽

Isometric Knee Extension ◽

Intermuscular Fat ◽

Prospective Longitudinal ◽

The Impact

Abstract Background: We assessed the quantitative changes in muscle mass and strength during two weeks of hospitalization in immobile and mobile acutely ill hospitalized older adults.Methods: 41 patients (82.4±6.6 years, 73.0% females) participated in this prospective longitudinal observational study. Mobility status was defined according to walking ability as described in the Barthel-Index. Functional status, including handgrip strength and isometric knee-extension strength, and mid-thigh magnetic resonance imaging measurements of cross-sectional area (CSA) were conducted on admission and at discharge. Results: Twenty-two participants (54%) were immobile and 19 (46%) mobile. In all, 54.0% and 12.0% were at risk of malnutrition and malnourished, respectively. The median time between baseline and follow-up for MRI scans were 13 days in mobile and immobile participants (P=0.072). Mid-thigh muscle and subcutaneous fat CSA significantly decreased by 3.9cm2 (5.0%, P=0.002) and 5.3cm2 (5.7%, P=0.036) during hospitalization whereas intermuscular fat remained unchanged in immobile subjects. No significant changes were observed in mobile patients. In a regression analysis, mobility was the major independent risk factor for changes in mid-thigh muscle CSA as a percentage of initial muscle area (P=0.022) whereas other variables such as age (P=0.584), BMI (P= 0.879), nutritional status (P=0.835) and inflammation (P=0.291) were not associated with muscle mass changes. There was a significant decrease in isometric knee extension strength (P=0.002) and no change in handgrip strength (P=0.167) in immobile patients whereas both parameters increased significantly over time in mobile patients (P=0.048 and P=0.012, respectively).Conclusions: Two weeks of disease-related immobilization result in a significant loss of thigh muscle mass and muscle strength in older patients with impaired mobility. Concomitantly, there was a significant reduction of subcutaneous adipose tissue in immobile older hospitalized patients whereas no changes were observed in intermuscular fat among these patients. These data should highlight the importance of mobility support in maintaining muscle mass and function in older hospitalized patients.

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The impact of disease-related immobilization on thigh muscle mass and strength in older hospitalized patients

10.21203/rs.3.rs-27443/v5 ◽

2020 ◽

Author(s):

Nikola Rommersbach ◽

Rainer Wirth ◽

Gero Lueg ◽

Christiane Klimek ◽

Mirja Schnatmann ◽

...

Keyword(s):

Muscle Mass ◽

Handgrip Strength ◽

Knee Extension ◽

Hospitalized Patients ◽

Thigh Muscle ◽

Knee Extension Strength ◽

Isometric Knee Extension ◽

Intermuscular Fat ◽

Prospective Longitudinal ◽

The Impact

Abstract Background: We assessed the quantitative changes in muscle mass and strength during two weeks of hospitalization in immobile and mobile acutely ill hospitalized older adults.Methods: 41 patients (82.4±6.6 years, 73.0% females) participated in this prospective longitudinal observational study. Mobility status was defined according to walking ability as described in the Barthel-Index. Functional status, including handgrip strength and isometric knee-extension strength, and mid-thigh magnetic resonance imaging (MRI) measurements of cross-sectional area (CSA) were conducted on admission and at discharge. Results: Twenty-two participants (54%) were immobile and 19 (46%) mobile. In all, 54.0% and 12.0% were at risk of malnutrition and malnourished, respectively. The median time between baseline and follow-up for MRI scans were 13 days in mobile and immobile participants (P=0.072). Mid-thigh muscle and subcutaneous fat CSA significantly decreased by 3.9cm2 (5.0%, P=0.002) and 5.3cm2 (5.7%, P=0.036) during hospitalization whereas intermuscular fat remained unchanged in immobile subjects. No significant changes were observed in mobile patients. In a regression analysis, mobility was the major independent risk factor for changes in mid-thigh muscle CSA as a percentage of initial muscle area (P=0.022) whereas other variables such as age (P=0.584), BMI (P= 0.879), nutritional status (P=0.835) and inflammation (P=0.291) were not associated with muscle mass changes. There was a significant decrease in isometric knee extension strength (P=0.002) and no change in handgrip strength (P=0.167) in immobile patients whereas both parameters increased significantly over time in mobile patients (P=0.048 and P=0.012, respectively).Conclusions: Two weeks of disease-related immobilization result in a significant loss of thigh muscle mass and muscle strength in older patients with impaired mobility. Concomitantly, there was a significant reduction of subcutaneous adipose tissue in immobile older hospitalized patients whereas no changes were observed in intermuscular fat among these patients. These data highlight the importance of mobility support in maintaining muscle mass and function in older hospitalized patients.

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The impact of disease-related immobilization on thigh muscle mass and strength in older hospitalized patients

10.21203/rs.3.rs-27443/v3 ◽

2020 ◽

Author(s):

Nikola Rommersbach ◽

Rainer Wirth ◽

Gero Lueg ◽

Christiane Klimek ◽

Mirja Schnatmann ◽

...

Keyword(s):

Muscle Mass ◽

Handgrip Strength ◽

Knee Extension ◽

Hospitalized Patients ◽

Thigh Muscle ◽

Knee Extension Strength ◽

Isometric Knee Extension ◽

Intermuscular Fat ◽

Prospective Longitudinal ◽

The Impact

Abstract Background: We assessed the quantitative changes in muscle mass and strength during two weeks of hospitalization in immobile and mobile acutely ill hospitalized older adults.Methods: 41 patients (82.4±6.6 years, 73.0% females) participated in this prospective longitudinal observational study. Mobility status was defined according to walking ability as described in the Barthel-Index. Functional status, including handgrip strength and isometric knee-extension strength, and mid-thigh magnetic resonance imaging (MRI) measurements of cross-sectional area (CSA) were conducted on admission and at discharge. Results: Twenty-two participants (54%) were immobile and 19 (46%) mobile. In all, 54.0% and 12.0% were at risk of malnutrition and malnourished, respectively. The median time between baseline and follow-up for MRI scans were 13 days in mobile and immobile participants (P=0.072). Mid-thigh muscle and subcutaneous fat CSA significantly decreased by 3.9cm2 (5.0%, P=0.002) and 5.3cm2 (5.7%, P=0.036) during hospitalization whereas intermuscular fat remained unchanged in immobile subjects. No significant changes were observed in mobile patients. In a regression analysis, mobility was the major independent risk factor for changes in mid-thigh muscle CSA as a percentage of initial muscle area (P=0.022) whereas other variables such as age (P=0.584), BMI (P= 0.879), nutritional status (P=0.835) and inflammation (P=0.291) were not associated with muscle mass changes. There was a significant decrease in isometric knee extension strength (P=0.002) and no change in handgrip strength (P=0.167) in immobile patients whereas both parameters increased significantly over time in mobile patients (P=0.048 and P=0.012, respectively).Conclusions: Two weeks of disease-related immobilization result in a significant loss of thigh muscle mass and muscle strength in older patients with impaired mobility. Concomitantly, there was a significant reduction of subcutaneous adipose tissue in immobile older hospitalized patients whereas no changes were observed in intermuscular fat among these patients. These data highlight the importance of mobility support in maintaining muscle mass and function in older hospitalized patients.

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The Impact of Malnutrition on Acute Muscle Wasting in Frail Older Hospitalized Patients

Kompass Nutrition & Dietetics ◽

10.1159/000516095 ◽

2021 ◽

pp. 1-2

Author(s):

Sousana Papadopoulou

Keyword(s):

Older Patients ◽

Muscle Wasting ◽

Handgrip Strength ◽

Knee Extension ◽

Hospitalized Patients ◽

Thigh Muscle ◽

Stepwise Multiple Regression ◽

Cross Sectional ◽

Prospective Longitudinal ◽

The Impact

Very little is known about the effect of malnutrition on short-term changes of body composition, particularly muscle, among older hospitalized patients. We sought to investigate the association of malnutrition as assessed by the Global Leadership Initiative on Malnutrition (GLIM) criteria with changes of thigh muscle mass and muscle strength among older patients during hospitalization. Forty-one patients (age range 66–97 years, 73% female) participated in this prospective longitudinal observational study. Nutritional status was evaluated using the GLIM criteria on admission and at discharge. Functional status and mid-thigh magnetic resonance imaging (MRI) measurements of cross-sectional area (CSA) were conducted on admission and before discharge. In all, 17% were malnourished and 83% had no malnutrition. Mean mid-thigh muscle CSA declined by 7.0 cm2 (−9%) in malnourished patients during hospitalization (<i>p</i> = 0.008) and remained unchanged among non-malnourished patients (−1%, <i>p</i> = 0.390). Mean mid-thigh CSA of subcutaneous and intermuscular fat did not change significantly during hospitalization in both groups. Malnourished subjects lost 10% of handgrip strength (−1.8 kg) and 12% of knee extension strength (−1.5 kg) during hospitalization. However, the magnitude of both changes did not differ between groups. In a stepwise multiple regression analysis, malnutrition and changes in body weight during hospitalization were the major independent risk factors for the reduction of muscle CSA. Malnutrition according to the GLIM criteria was significantly and independently associated with acute muscle wasting in frail older patients during 2-week hospitalization.

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The Impact of Malnutrition on Acute Muscle Wasting in Frail Older Hospitalized Patients

Nutrients ◽

10.3390/nu12051387 ◽

2020 ◽

Vol 12 (5) ◽

pp. 1387 ◽

Cited By ~ 2

Author(s):

Maryam Pourhassan ◽

Nikola Rommersbach ◽

Gero Lueg ◽

Christiane Klimek ◽

Mirja Schnatmann ◽

...

Keyword(s):

Older Patients ◽

Muscle Wasting ◽

Handgrip Strength ◽

Knee Extension ◽

Hospitalized Patients ◽

Thigh Muscle ◽

Stepwise Multiple Regression ◽

Cross Sectional ◽

Prospective Longitudinal ◽

The Impact

Very little is known about the effect of malnutrition on short-term changes of body composition, particularly muscle, among older hospitalized patients. We sought to investigate the association of malnutrition as assessed by the Global Leadership Initiative on Malnutrition (GLIM) criteria with changes of thigh muscle mass and muscle strength among older patients during hospitalization. Forty-one patients (age range 66–97 years, 73% female) participated in this prospective longitudinal observational study. Nutritional status was evaluated using the GLIM criteria on admission and at discharge. Functional status and mid-thigh magnetic resonance imaging (MRI) measurements of cross-sectional area (CSA) were conducted on admission and before discharge. In all, 17% were malnourished and 83% had no malnutrition. Mean mid-thigh muscle CSA declined by 7.0 cm2 (−9%) in malnourished patients during hospitalization (p = 0.008) and remained unchanged among non-malnourished patients (−1%, p = 0.390). Mean mid-thigh CSA of subcutaneous and intermuscular fat did not change significantly during hospitalization in both groups. Malnourished subjects lost 10% of handgrip strength (−1.8 kg) and 12% of knee extension strength (−1.5 kg) during hospitalization. However, the magnitude of both changes did not differ between groups. In a stepwise multiple regression analysis, malnutrition and changes in body weight during hospitalization were the major independent risk factors for the reduction of muscle CSA. Malnutrition according to the GLIM criteria was significantly and independently associated with acute muscle wasting in frail older patients during 2-week hospitalization.

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Iron deficiency, fatigue and muscle strength and function in older hospitalized patients

European Journal of Clinical Nutrition ◽

10.1038/s41430-020-00742-z ◽

2020 ◽

Cited By ~ 1

Author(s):

Sophia Neidlein ◽

Rainer Wirth ◽

Maryam Pourhassan

Keyword(s):

Risk Factor ◽

Iron Deficiency ◽

Barthel Index ◽

Independent Risk Factor ◽

Iron Supplementation ◽

Handgrip Strength ◽

Knee Extension ◽

Hospitalized Patients ◽

Knee Extension Strength ◽

Prospective Longitudinal

Abstract Background/Objectives Iron deficiency is common in older patients. We investigated whether iron deficiency is an independent risk factor for functional impairment, low muscle function, fatigue, and rehabilitation progress in older hospitalized patients. Subjects/Methods Two hundred twenty-four patients (age range 65–95 years; 67% females) who were consecutively admitted to a geriatric acute care ward participated in this prospective longitudinal observational study. Ferritin, iron, transferrin in serum, and blood hemoglobin were measured and current iron supplementation was recorded. Fatigue and comorbidity were measured using the fatigue severity scale and Charlson Comorbidity Index, respectively. Barthel Index, handgrip strength, and isometric knee extension strength were conducted at the time of hospital admission and before discharge. Results Ninety-one (41%) patients had iron deficiency in which the majority had functional iron deficiency (78/91, 86%). Absolute iron deficiency with and without anemia was diagnosed in 12 (13%) and one patients, respectively. Barthel Index and handgrip and knee extension strength significantly improved during hospitalization in iron deficiency and non-iron deficiency groups. Knee extension strength showed better improvement in iron-deficient patients receiving iron supplementation and iron supplementation during hospital stay was the main predictor for improvement in knee extension strength. Comorbidity, iron deficiency, and changes in handgrip strength were the major independent risk factors for poor improvement in Barthel Index during hospitalization. There were significant associations between patients’ fatigue and iron deficiency, comorbidity, and female gender. Conclusion Iron deficiency is an independent risk factor for fatigue and poor functional recovery among older hospitalized patients. Iron supplementation seems to be capable of improving functional performance.

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ACTN3 Genotypes and Their Relationship with Muscle Mass and Function of Kosovan Adults

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18179135 ◽

2021 ◽

Vol 18 (17) ◽

pp. 9135

Author(s):

Arben Boshnjaku ◽

Ermira Krasniqi ◽

Harald Tschan ◽

Barbara Wessner

Keyword(s):

Muscle Mass ◽

Handgrip Strength ◽

Knee Extensor ◽

Peak Torque ◽

Knee Extension ◽

Cross Sectional Study ◽

Genotype Distribution ◽

Cross Sectional ◽

And Function ◽

The Impact

Maintaining muscle mass and function is important throughout the lifestyle. While environmental factors such as physical activity and healthy nutrition are well investigated, the contribution of genetic factors is still controversial. Therefore, we aimed to investigate the impact of a common ACTN3 polymorphism (rs1815739) on body composition, handgrip strength, knee extensor peak torque, and physical performance (gait speed, 30-s arm curl, 30-s chair stand) in Kosovan adults. In total, 308 participants (160 females and 148 males, age range from 40 to 91 years) took part in this cross-sectional study. Genomic DNA was extracted from saliva and assessed for ACTN3 genotype distribution (41.5% of RR, 53.9% of RX and 4.6% of XX). Genotype allocation did not account for differences in any of the variables. Interestingly, female XX carriers were taller (p = 0.025) and had a higher isokinetic knee extension peak torque (p = 0.024) than the RX+RR group. In males, XX carriers were also taller (p = 0.049) and had a lower BMI (p = 0.026), but did not differ in any of the strength and performance parameters. These results indicate that the ACTN3 R577X polymorphism might exert a sex-specific impact on knee extensor peak torque and BMI.

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EARLY STRENGTH TESTING AFTER ACL RECONSTRUCTION IMPACTS ISOKINETIC STRENGTH PERFORMANCE AT TIME OF RETURN TO SPORT

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00119 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0011

Author(s):

Adam Weaver ◽

Dylan Roman ◽

Maua Mosha ◽

Nicholas Giampetruzzi

Keyword(s):

Test Performance ◽

Knee Extension ◽

Strength Test ◽

Strength Testing ◽

Isokinetic Strength ◽

Rehabilitation Process ◽

Strength Performance ◽

Knee Extension Strength ◽

Isometric Knee Extension ◽

Strength Tests

Background: The standard of care in ACL reconstruction (ACLR) typically involves standardized strength testing at 6 months or later to assess a patient’s readiness to return to play (RTP) using isokinetic and isometric testing, and functional strength testing. Recent literature suggests that isokinetic knee extension strength should demonstrate 89% limb symmetry index (LSI) or greater prior to returning to sport. However, there is little known on the effects of strength testing early in the rehabilitation process and the relationship to strength test performance at time of RTP. Purpose: The purpose of this study was to examine how early post-operative strength test performance impacts isokinetic strength outcomes at RTP testing in adolescents. Methods: The retrospective cohort study included patients undergoing primary ACLR between 12 and 18 years of age, early post-operative strength measures, and isokinetic dynamometer strength at RTP from July 2017 and April 2019. Data was dichotomized into desired outcomes at 3 months: >70% isometric knee extension LSI, > 20 repetitions on anterior stepdown test (AST), > 90% LSI Y Balance. At RTP testing, isokinetic knee extension strength data was categorized into >89% LSI at 3 speeds (300, 180, 60°/sec). Chi square testing and odds ratio statistics were used to examine association and its magnitude. Results: 63 patients met inclusion criteria (38 females; 15.37±1.66 years old). >70% LSI isometric knee extension strength at 3 months showed a significant association (Table 2) and demonstrated the strongest odds of having >89% LSI on isokinetic strength tests at all 3 speeds at RTP with 180°/sec being the highest (OR=14.5; 95% CI=4.25,49.43; p= <0.001). Performance on AST showed a significant association (χ2 (1, n=63) = 17.00, p <0.001), and highest odds at 180°/sec (OR=4.61; 95% CI = 1.59, 13.39, p=<0.001) and 60°/sec (OR= 3.07; 95% CI = 1.10, 8.63, p= 0.04). Combination of performance on isometric strength tests and AST showed a significant association to isokinetic strength at all three speeds, but less predictive then isometrics in isolation. (Table 2). There was no significant relationship between YBR LSI at 3 months and isokinetic strength at 6 months. Conclusion: Standardized strength testing early in rehabilitation can help identify patients that will successfully complete RTP testing. Our results suggest that isometric knee extension strength and timed anterior stepdown test provide meaningful clinical information early in the rehabilitation process. This data also suggests that the use of YBAL for predicting isokinetic strength performance is limited. [Table: see text][Table: see text]

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