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Skelatal Muscle in Health and Disease > SKM in health and disease > Flashcards

SKM in health and disease Flashcards

1
Q

What is the importance of muscle ina geing?

A
  • Older muscle demonstrates blunted anabolic response
  • reduction of anabolic hormones such as testosterone and IGF-1 with age
  • Spinal motorneurones are lost with age
  • Overall loss of function/ loss of QOL
  • Reduced longevity
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2
Q

What is sarcopenia?

A

1.) Low muscle mass
SKM index (kg,m2) <2xSD normal
2 .Low muscle strength
.Handgrip <30 kg men, <20 kg women
3. Low physical peformance
- reduced short physical performance battery test (Balance, gait, speed, chair stanf)
- Gait speed <1m/ over 6m course

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3
Q

What is functional sarcopenia?

A

Prevalent in 5-13% in the 60-70 age group
- 50% in the over 80s
- Imparts a risk of adverse outcomes such as
- physical disability
- poor quality of life
- death

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4
Q

What is cachexia?

A
  • Complex metabolic syndrome associated with underlying illness E.G. Cancer, CCF, renal failure
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5
Q

What is frality?

A
  • Age-related cumulative decline across multiple systems
  • Decreased physiological reserve
  • Poorly defined
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6
Q

What is the hospital outcome of sarcopenia?

A
  • 1000 patients admitted to hospital
  • Hospital LOS > 12 days increased in sarcopenia
  • odds ratio = 5.6 men, 4.9 in women
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7
Q

What is the link between muscle mass and physical performance?

A
  • Muscle - 18% energy consumption at rest
  • 45x increase with exercise
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8
Q

What is the link between sarcopenia and morbidity?

A

Sarcopaenia predicts:
- increased functional loss
- Reduced physical performance
- reduced quality of life
- Increased risk of hospitalisation
- Reduced longevity
- Disability
- Death

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9
Q

Explain the survival of muscle mass post cancer surgery

A
  • Non-curative surgery
  • CT assessed lean muscle mass
  • Muscle mass = better predictor of longevity than primary, age or gender
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10
Q

What is the link between cancer and muscle mass?

A

Elderly - often sarcopenic
Major surgery induces muscle loss - 5-20%
Leads to functional impairment and complications
Pronounced cachectic muscle - loss in cancer
- Dependent upon primary
- CRC patients often sarcopenic
- 25% ocer preceding 6/12
- BMI often preseved
- Sarcopenia not apparent

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11
Q

Explain the concepts of surgical stress response

A

Surgical stress response :
1. Autonomic- sympathetic tone
2. Inflammatory - IL-6, IL-1, tissue necrosis factor
3. Endocrine - cortisol, adrenaline, insulin
4. Metabolic- serum glucose levels, basal metabolic rate

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12
Q

Explain what happens following tissue injury

A
  1. Tissue injury
  2. Surgical stress response and cytokine release
  3. Muscle (MPB>MS = decrease in mass) - metabolic, endocrine, inflammatory
  4. Increased circulating amino-acids
  5. Liver - gluconeogenesis & protein production
  6. Increased circulationg glucose and acute phase proteins
  7. Tissue repair - neg feedback leads back to cytokine release
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13
Q

What is CRC resection in sarcopenia?

A
  • Sarcopenic CRC patients
  • Increased LOS of between 30-50%
  • Double risk of post op chest infection rate
  • 2-3 x overall complicationn rate
  • OR 30 day mortality 15.5
  • Literature findings consistent over 20 years
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14
Q

How to investigate SKM

A
  • Muscle mass
  • Muscle synthesis and breakdown
  • Physical performance
  • Measures of morbidity and mortality
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15
Q

How do we measure muscle turnover?

A
  • stable isotope labelling
  • Naturally occuring heavy elements
  • 2H, 13C, 15N etc
  • Incorporated into tracer
  • Usually amino acids
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16
Q

What are objective and subjective score measurements in physical performance?

A
  • Objective scores:
  • Hand grip strength
  • Knee extension
  • Short physical performance battery
  • CPEX

Subjective scores :
- DASI
- EQ5D

17
Q

What is the difference in muscle mitochondrial function?

A
  • Muscle bx
  • Decrease PDH activity
  • Decrease in Kreb’s cycle
  • Increase in inflammatory markers e.g. NFkB
  • Normalisation post-tumour resection
18
Q

Explain the change in muscle mass preopertatively

A
  • Reduced SKM mass
  • Sarcopenia
  • Cachexia
  • Reduced muscle synthesis
  • Impaired aerobic peformance vs controls
  • Increased intramuscular inflammation
  • Decreased mitochondrial function
19
Q

Explain the change in muscle mass post-operatively

A
  • Initial rapid loss of muscle mass (-5%) and strength (~25%)
  • By 8 weeks
  • Normalisation of inflammatory markers
  • Restoration of muscle synthesis
  • By 9-10 months
  • restoration of muscle mass
  • Increase in VO2AT toward matched controls
  • Subjective assessment of performance still decreased
20
Q

What are the options to improve peformance in the elderly?

A
  • Pharmacological therapies
  • Nutritional therapies
  • Physical and exercise therapies
  • Resistance exercise training (RET)
  • Endurance exercise training (EET)
  • High Intensity Interval Training (HIIT)
21
Q

What are pharmacological therapies in the elderly?

A

Testosterone, growth hormone
Incease bulk
Associated with side effects
- little functional improvement
- EPA anti-inflammatory
- Increases FSR in some circumstances

22
Q

What are some nutritional therapies in the elderly?

A
  • Chronic protein supplementation
  • small gain in weight and physical performance
  • Pulsed vs bolus feeding muscle full phenomena
  • Greater benefit with pulsed feeding
23
Q

What is the exercise training in the elderly?

A
  • Restrictive exercise training
    3-12/12 increase in strength and mass (20 &10 %)
  • Small increase in aerobic performance
  • Endurance exercise training (E.g. cycling)
  • 3-12/12 little increase in muscle mass
  • Reduces muscle breakdown
  • Improves cardiac performance
  • HHIT
  • gains in aerobic performance
24
Q

What is HIIT?

A
  • Short high intensity exercise
  • Effective in healthy individuals
  • Less time spent exercising
  • Quick results
25
Q

How can we improve performance cancer?

A
  • Therapies
  • Nutritonal (unlikely to be of benefit)
  • Pharmacological therapies
  • EPA
  • Exercise therapies (if time frame compliant)
  • Issues
  • Decrease in muscle mass, aerobic function, inflammation
  • 31 day time frame
26
Q
A
27
Q

What is meta-analysis: training prior to cancer surgery?

A
  • Studies with non-exercise control groups and those with pre and post exercise
  • 8 included studies
  • Mean length of exercise programme 34 days
  • 3 main research groups
  • All used aerobic exercise as primary intervention
  • High risk of bias
  • Increased 6 min walk test by 37 meters
  • 30-40 m clinically significant
  • Complications non-sig difference
  • Underpowered, To show 10% decrease in complications need 400 patients
  • Limited evidence to show increase in objective measures of cardiorespiratory fitness
28
Q

What are SKM improvements prior to cancer surgery?

A
  • Pharmacological/nutritional Tx unlikely beneficial
  • Exercise training
  • Improvements in 6 min walk test
  • HIIT deliverable in 31 days in patients
  • HIIT shows evidence of benefit in some comorbidities
  • Not yet shown to be effective in CRC

Skelatal Muscle in Health and Disease (16 decks)

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