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      High Intensity Resistance Exercise Training to Improve Body Composition and Strength in Older Men With Osteosarcopenia. Results of the Randomized Controlled Franconian Osteopenia and Sarcopenia Trial (FrOST)

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          Abstract

          Considerably decreased muscle mass and function are subsumed under “sarcopenia,” a geriatric syndrome. Dedicated exercise programs maintain muscle mass and function; however, due to the limited enthusiasm of older adults to exercise, it is important to generate low-threshold interventions for this vulnerable cohort. Thus, the primary aim of this study was to determine the effect of low volume/high intensity resistance exercise training (HIT-RT) combined with protein supplementation on body composition and strength in older men with sarcopenia and osteopenia (osteosarcopenia). Forty-three community-dwelling (cdw) older men (78 ± 4 years) with osteosarcopenia were randomly allocated to a consistently supervised HIT-RT ( n = 21) or an inactive control group (CG, n = 22). HIT-RT scheduled a single set protocol with high intensity and effort applied twice a week for 36 weeks so far. Both groups were supplemented with Vit-D (800 IE/d), calcium (1,000 mg/d) and whey-protein (CG: 1.2 vs. HIT-RT: 1.5–1.7 g/kg/d). Study endpoints were body composition (dual-energy x-ray absorptiometry) and maximum isokinetic hip/leg-extensor strength (MIES) by leg-press. After 36 weeks, one participant who developed prostate cancer after inclusion in the study (HIT-RT) and two participants who lost interest (CG, HIT-RT) quit the study. Attendance rate for HIT-RT averaged 93 ± 5%. Total and thigh lean body mass (LBM) significantly ( p < 0.001) increased in the HIT-RT and was maintained in the CG ( p = 0.46 and 0.37). Differences between the groups for changes of total and thigh LBM were pronounced ( p < 0.001; SMD d′ = 1.17 and 1.20). Total and abdominal body fat percentage decreased significantly in the HIT-RT ( p < 0.001) and increased in the CG ( p = 0.039 and p = 0.097). Intergroup differences were significant ( p < 0.001; SMD: d′ = 1.35 and 1.28). Finally, MIES was maintained in the CG ( p = 0.860), and improved significantly ( p < 0.001) in the HIT-RT. Differences between the groups were significant ( p < 0.001, SMD: d′ = 2.41). No adverse effects of the intervention were observed. In summary, the HIT-RT/protein protocol significantly affected body composition and strength in cdw men 72 years+ with osteosarcopenia. In the absence of negative side effects, the intervention was feasible, attractive and time effective. Thus, we conclude that supervised HIT-RT might be an exercise option for older men.

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          World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.

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            Sarcopenia: revised European consensus on definition and diagnosis

            Abstract Background in 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a sarcopenia definition that aimed to foster advances in identifying and caring for people with sarcopenia. In early 2018, the Working Group met again (EWGSOP2) to update the original definition in order to reflect scientific and clinical evidence that has built over the last decade. This paper presents our updated findings. Objectives to increase consistency of research design, clinical diagnoses and ultimately, care for people with sarcopenia. Recommendations sarcopenia is a muscle disease (muscle failure) rooted in adverse muscle changes that accrue across a lifetime; sarcopenia is common among adults of older age but can also occur earlier in life. In this updated consensus paper on sarcopenia, EWGSOP2: (1) focuses on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarcopenia diagnosis, and identifies poor physical performance as indicative of severe sarcopenia; (2) updates the clinical algorithm that can be used for sarcopenia case-finding, diagnosis and confirmation, and severity determination and (3) provides clear cut-off points for measurements of variables that identify and characterise sarcopenia. Conclusions EWGSOP2's updated recommendations aim to increase awareness of sarcopenia and its risk. With these new recommendations, EWGSOP2 calls for healthcare professionals who treat patients at risk for sarcopenia to take actions that will promote early detection and treatment. We also encourage more research in the field of sarcopenia in order to prevent or delay adverse health outcomes that incur a heavy burden for patients and healthcare systems.
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              Sarcopenia: European consensus on definition and diagnosis

              The European Working Group on Sarcopenia in Older People (EWGSOP) developed a practical clinical definition and consensus diagnostic criteria for age-related sarcopenia. EWGSOP included representatives from four participant organisations, i.e. the European Geriatric Medicine Society, the European Society for Clinical Nutrition and Metabolism, the International Association of Gerontology and Geriatrics—European Region and the International Association of Nutrition and Aging. These organisations endorsed the findings in the final document. The group met and addressed the following questions, using the medical literature to build evidence-based answers: (i) What is sarcopenia? (ii) What parameters define sarcopenia? (iii) What variables reflect these parameters, and what measurement tools and cut-off points can be used? (iv) How does sarcopenia relate to cachexia, frailty and sarcopenic obesity? For the diagnosis of sarcopenia, EWGSOP recommends using the presence of both low muscle mass + low muscle function (strength or performance). EWGSOP variously applies these characteristics to further define conceptual stages as ‘presarcopenia’, ‘sarcopenia’ and ‘severe sarcopenia’. EWGSOP reviewed a wide range of tools that can be used to measure the specific variables of muscle mass, muscle strength and physical performance. Our paper summarises currently available data defining sarcopenia cut-off points by age and gender; suggests an algorithm for sarcopenia case finding in older individuals based on measurements of gait speed, grip strength and muscle mass; and presents a list of suggested primary and secondary outcome domains for research. Once an operational definition of sarcopenia is adopted and included in the mainstream of comprehensive geriatric assessment, the next steps are to define the natural course of sarcopenia and to develop and define effective treatment.
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                Author and article information

                Contributors
                Journal
                Front Sports Act Living
                Front Sports Act Living
                Front. Sports Act. Living
                Frontiers in Sports and Active Living
                Frontiers Media S.A.
                2624-9367
                28 January 2020
                2020
                : 2
                : 4
                Affiliations
                [1] 1Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg , Erlangen, Germany
                [2] 2Faculty of Medical and Life Sciences, Furtwangen University , Villingen-Schwenningen, Germany
                [3] 3Institute of Sports Science, University of Koblenz-Landau , Landau, Germany
                [4] 4Department of Sports Science, University of Kaiserslautern , Kaiserslautern, Germany
                Author notes

                Edited by: Giuseppe D'Antona, University of Pavia, Italy

                Reviewed by: Brad Schoenfeld, Lehman College, United States; Moritz Schumann, German Sport University Cologne, Germany

                *Correspondence: Wolfgang Kemmler wolfgang.kemmler@ 123456imp.uni-erlangen.de

                This article was submitted to Exercise Physiology, a section of the journal Frontiers in Sports and Active Living

                Article
                10.3389/fspor.2020.00004
                7739651
                33344999
                ef62c570-f66d-48f4-9e79-432b4fffd1c7
                Copyright © 2020 Kemmler, Weineck, Kohl, von Stengel, Giessing, Fröhlich and Schoene.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 25 October 2019
                : 08 January 2020
                Page count
                Figures: 1, Tables: 4, Equations: 0, References: 71, Pages: 12, Words: 10022
                Categories
                Sports and Active Living
                Clinical Trial

                high intensity,resistance exercise,sarcopenia,osteopenia,older men,fat free mass,muscle strength

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