Telerehabilitation is Effective to Recover Functionality and Increase Skeletal Muscle Mass Index in COVID-19 Survivors

Objective: The purpose of this study was to evaluate the effects of a telerehabilitation program for COVID-19 survivors on their functionality, aerobic capacity, upper-lower body strength and skeletal muscle mass index. Methods: Fifty patients (22 M); age 54.1±15.4 who became ill with COVID-19 during 2020 completed a 24-session telerehabilitation program. The following measures were taken: Barthel’s index, two minutes step test (2MST), elbow flexion one-repetition maximal (1RM), short physical performance battery (SPPB), hand grip strength, 30-second chair stand, skeletal muscle index (SMI), body fat percentage, resting pulse, arterial blood pressure, and pulse oximetry. Results: There was a significant increase in the Barthel index (p?0.0001), 2MST (p?0.0001), 1RM elbow flexion (p?0.0001), SPPB (p?0.0001), hand grip strength (p?0.0001), 30-second chair stand (p?0.0001), and SMI (p?0.0001). Conclusion: A 24 session in-home telerehabilitation program promoted the recovery of physical independence and increases in skeletal muscle mass index and physical fitness.

Association between Geriatric Nutrition Risk Index and The Presence of Sarcopenia in People with Type 2 Diabetes Mellitus: A Cross-Sectional Study

The aim of this cross-sectional study was to examine the association between the geriatric nutritional risk index (GNRI) and the prevalence of sarcopenia in people with type 2 diabetes (T2DM). Having both low handgrip strength (<28 kg for men and <18 kg for women) and low skeletal muscle mass index (<7.0 kg/m2 for men and <5.7 kg/m2 for women) was diagnosed as sarcopenia. GNRI was estimated by the formula as below: GNRI = (1.489 × serum albumin level [g/L]) + (41.7 × [current body weight (kg)/ideal body weight (kg)]). Participants were dichotomized on the basis of their GNRI scores (GNRI < 98, low; or GNRI ≥ 98, high). Among 526 people (301 men and 225 women) with T2DM, the proportions of participants with sarcopenia and low GNRI were 12.7% (n = 67/526) and 5.1% (n = 27/526), respectively. The proportion of sarcopenia in participants with low-GNRI was higher than that with high GNRI (44.4% [n = 12/27] vs. 11.0% [n = 55/499], p < 0.001). The GNRI showed positive correlations with handgrip strength (r = 0.232, p < 0.001) and skeletal muscle mass index (r = 0.514, p < 0.001). Moreover, low GNRI was related to the prevalence of sarcopenia (adjusted odds ratio, 4.88 [95% confidence interval: 1.88–12.7], p = 0.001). The GNRI, as a continuous variable, was also related to the prevalence of sarcopenia (adjusted odds ratio, 0.89 [95% confidence interval: 0.86–0.93], p < 0.001). The present study revealed that low GNRI was related to the prevalence of sarcopenia.

Influence of the appendicular skeletal muscle mass index on the bone mineral density of postmenopausal women

Background The appendicular skeletal muscle mass index (ASMI) is an important risk indicator for osteoporosis because of the anatomical proximity and metabolic connection between muscle and bone mass. The present study investigated the relationship between ASMI and the bone mineral density (BMD) categories of postmenopausal women. Methods In this cross-sectional study with a probabilistic sample, sociodemographic, lifestyle, menopause time, anthropometric, and physical activity variables were collected. ASMI and BMD were assessed by dual-energy X-ray absorptiometry (DXA). Participants were grouped according to BMD values into normal density, osteopenia, and osteoporosis. Multivariate logistic regression models were applied to verify the influence of ASMI on BMD. Data were analyzed using the SPSS statistical software, version 22. The significance level for all tests was set at 5%. Results Of the 114 women analyzed, most were between 60 and 69.9 years of age (62.3%), on menopause for ≤19.0 (51.8%), self-declared brown race/color (49.1%), had < 4 years of education (41.2%), never smoked (69.0%) or drank alcohol (62.8%). Of these, 52.6% were classified as sufficiently active and 52.2% had regular sun exposure. Women with osteoporosis were older (p = 0.035), on menopause for a longer time (p = 0.011), underweight (p = 0.004), had adequate waist circumference (p = 0.017), and low ASMI values (p = 0.002). There was an association between the 1st tertile of ASMI and osteoporosis. However, after adjustments for age, race/color, and body mass index, the strength of association between BMD and ASMI was not maintained. Conclusions ASMI was not associated with the BMD of the postmenopausal women evaluated. Total body and muscle mass, in addition to bone mass, should be monitored during menopause treatment. Longitudinal studies must be conducted to elucidate the mechanisms and gaps in this relationship.

The Relationship Between Sarcopenia Detected In Newly Diagnosed Colorectal Cancer Patients And FGF21, Irisin And CRP Levels.

Aim: Sarcopenia is a progressive and generalized syndrome that can be linked to many causes such as cancers, and is caused by a quantitative and qualitative disorder (loss of muscle strength and / or physical performance) of skeletal muscle mass. Although sarcopenia has some hypothetical explanation in clinical practice, the mechanisms underlying this condition have not been clearly differentiated in patients with cancer. We aimed to investigate the relationship between irisin and FGF21 in detecting sarcopenia in colorectal cancer patients.Material and Method: Current prospectively study included non-metastatic newly diagnosed colorectal cancer patients. Patients were divided into two groups of 25 people, those with and without sarcopenia. Body composition measurements by examined by BIA. To measure the level of iris and FGF21 from patients, blood samples were taken into the biochemistry tube and their levels were measured. Results: The median age of the patients included in the study was 60 years (range: 21-81), 68 % were men. It was found that there was a significant relationship between sarcopenia and gender and BMI measurement. When Spearman correlation analysis was performed between skeletal muscle mass index and FGF21, irisin and CRP, there was a positive correlation between skeletal muscle mass index and irisin and FGF21, while there was a negative correlation between skeletal muscle mass index and CRP. [respectively: (r: 0.282, p: 0.048), (r: 0.564, p: <0.001) and (r: -0.360, p: 0.010). Similar results were found between hand grip strength and FGF21, irisin and CRP. [respectively: (r: 0.342, p: 0.015), (r: 0.290, p: 0.041) and (r: -0.476, p <0.001)]. When sarcopenia was treated as the dependent variable in the logistic regression analysis, and FGF21, irisin, CRP, gender and BMI were treated as the independent variables, irisin and CRP levels were determined as independent predictors. Conclusion: This study was revealed that there is a negative relationship between sarcopenia and irisin and FGF-21 in operated non-metastatic colorectal cancer patients and there may be a relationship between sarcopenia and inflammation. It suggest that these biomarkers may play a role in the pathophysiology of sarcopenia. However, our results need to be validated in different types of cancer and with more patients.

Appendicular Skeletal Muscle Mass Index and Physiological Performance in Post-Menopausal Women with Total Thyroidectomy

Sarcopenia is prevalent in postmenopausal women but is inconclusive in total thyroidectomy and under levothyroxine replacement. We aim to analyze the determinants of sarcopenia and investigate the early detection of sarcopenia in this group. Fifty postmenopausal women with total thyroidectomy were measured for body composition via Dual-energy X-ray Absorptiometry (DXA) and Appendicular Skeletal Muscle mass divided by the height square (ASM/ht2). Handgrip strength and gait speed and Geriatric Nutritional Risk Index (GNRI) were calculated. Eight determinants associated with sarcopenia include GNRI (β, 0.042; 95% confidence interval (CI), 0.021 to 0.064), femoral neck BMD (β, 0.989; 95% CI, 0.049 to 1.929), TSH (β, 0.192; 95% CI, 0.027 to 0.357), and thyroglobulin Ab (0.657; 95% CI, 0.210 to 1.103) for ASM/height2; menopausal years (β, −3.112; 95% CI, −5.661 to −0.563) and ASM/height2 (β, 2.669; 95% CI, 1.073 to 4.265) for handgrip strength; and GNRI (β, 0.062; 95% CI, 0.019 to 0.105), T3 (β, −3.541; 95% CI, −7.019 to −0.063), and age (β, 0.043; 95% CI, 0.003 to 0.084) for gait speed. Our study confirmed a high prevalence of low skeletal muscle mass index in postmenopausal women with total thyroidectomy and revealed a number of determinants that could help early diagnosis and management this disease in daily clinical practice.

Effect of Rehabilitation Nutrition on a Post-Acute Severe COVID-19 Patient: A Case Report

Coronavirus disease 2019 (COVID-19) may lead to post-acute physical function deterioration due to intensive-care-unit-acquired weakness-related sarcopenia and dyspnea. Limited reports have examined the effects of rehabilitation and nutritional therapy on patients with post-acute COVID-19. We present the case of a 67-year-old man, who was admitted for the treatment of post-acute severe COVID-19, who benefited from rehabilitation nutrition. When the patient’s condition stabilized, sarcopenia and malnutrition were observed, and rehabilitation nutrition was implemented. The physical therapist implemented a program focused mainly on resistance training and aerobic exercise, and the dietitian provided oral nutritional supplements and hospital food that met the patient’s energy and protein intake requirements. Comparing the initial evaluations with those at discharge, factors affecting nutritional status, such as body mass index and skeletal muscle mass index, and physical functions, such as grip strength and walking speed, and dyspnea, had improved. The patient was discharged and returned to work. This case suggests improvements in the nutritional status and physical functions of post-acute severe COVID-19 patients by interventions following rehabilitation nutrition.

Skeletal Muscle Mass Index cut-offs by bioelectrical impedance analysis to determine Sarcopenia Based on healthy young or old Populations: A Comparative Study

Skeletal muscle mass index (SMMI) is a component in sarcopenia. There is no universal cut-off point and therefore each population should have its own reference values. This study aimed comparing SMMI cut-off points derived from a young population with those obtained directly from an elderly population. 237 older adult community-dwelling older than 60 years were evaluated. The skeletal muscle mass (SMM) was evaluated by bioelectrical impedance analysis (BIA). SMMI was calculated as SMM/height squared. The young population consisted of 255 participants from the same locality. The cut-off points from older person for moderate low muscle mass were 6.70 (women) and 9.20 kg/m2 (men). In this case, they were higher than those estimated from the young population (6.42 and 8.40 kg/m2for women and men). A similar trend was obtained when the cut-off points were set below the 20th percentile. When two standard deviations were used to determine the cut-off points, the values for older women were lower (5.90 kg/m2) than those obtained from young adults. There were no differences in the case of men. SMMI reference values from elderly persons is an option to diagnose sarcopenia, however prospective studies are necessary to stablish the capacity to predict functional outcomes.