Effects of Multicomponent Training on Sarcopenia

The Effects of an 8-week Multicomponent Training Program on Quality of Life, Fear of Falling, & Physical Performance in Community-Dwelling Older Adults With Probable Sarcopenia

The purpose of the study is to determine whether community-dwelling older adults with probable sarcopenia (muscle loss) will experience improved patient-reported outcomes and physical performance after completing an 8-week multicomponent exercise training program when compared to a control group who does not complete the intervention. As an additional aim, subjects who participate in the exercise intervention will be asked about their experiences to identify factors that contribute to positive health behaviors in community-dwelling older adults.

Sarcopenia is a geriatric syndrome which involves the progressive loss of muscle mass and physical performance in aging adults. The age-related decline inherent to sarcopenia has been shown to be a precursor to falls, disability, and mortality. Exercise is a non-pharmacological intervention that has been shown to prevent and manage the progression of sarcopenia, however there is limited research regarding its effect on patient-reported outcomes in older adults. The purpose of this study is to examine the effects of an 8-week multicomponent training program on quality of life, fear of falling, and physical performance in community-dwelling older adults with probable sarcopenia. A convenient sample of community-dwelling older adults aged 65 years and older referred by a physician from an outpatient medical center in Northeast Pennsylvania will be assessed for "probable sarcopenia" and recruited to participate. Eligible subjects will be randomly assigned to an intervention group who will attend two group-based sixty-minute standardized sessions per week supervised by an experienced professional in the outpatient medical center or a comparison group composed of patients who did not perform the intervention. Outcomes testing will occur for both groups prior to, at the mid-point (4 weeks), and following the completion of the exercise intervention (8 weeks). Semi-structured, individual interviews with selected participants who complete the intervention will be conducted by the researcher in the designated research environment to assess barriers, drivers, and the overall experience of the intervention. The study will evaluate the following research questions: Will an 8-week multicomponent exercise intervention improve quality of life in community-dwelling older adults with probable sarcopenia? Will an 8-week multicomponent exercise intervention improve fear of falling in community-dwelling older adults with probable sarcopenia? Will an 8-week multicomponent exercise intervention improve physical performance in community-dwelling older adults with probable sarcopenia? Will an 8-week multicomponent exercise intervention improve hand grip strength in community-dwelling older adults with probable sarcopenia? What are the drivers and barriers of exercise adherence for community-dwelling older adults with probable sarcopenia who experienced an 8-week multicomponent exercise intervention? Data analysis will include a two-way ANOVA to determine between-group effects and an ANCOVA to calculate for other factors such as important group characteristics at baseline. A Tukey post hoc test will be used to evaluate where differences occur (pre-, mid-, post-). General ideas and emerging themes will be inductively coded by the researcher from the post-intervention interview transcripts. The duration of the study is expected to be sixteen weeks and is dependent upon the recruitment process. The study is significant because it will assess whether the program is a feasible intervention that can be implemented by providers to aid in the management of probable sarcopenia for community-dwelling older adults. The findings of this study will offer providers evidence-based practices that can be used for effective multicomponent exercise training prescription.

Multicomponent Physical Activity, Older Adult, Quality of Life, Fear of Falling, Physical Performance

A mixed-methods study design will be used to assess the effectiveness of a multicomponent training program on quality of life, fear of falling, and physical performance in older adults with probable sarcopenia. The study includes a pre-mid-post-test design with an intervention group who will perform an 8-week multicomponent training program and a comparison group composed of patients who do not perform the intervention.

Subjects in the intervention group will attend two standardized group-based sixty-minute sessions per week in the outpatient medical center and will be asked not to change their current physical activity regimen during the 8-week duration of the study.

Subjects in the control group will be asked to not change their current level of physical activity during the 8-week duration of the study.

The intervention will be implemented and supervised by a well-trained, highly experienced professional with post-graduate education in the fields of exercise science and health promotion. Each session will consist of three phases: warm-up/initiation, conditioning, and cooldown. The intervention will be composed of aerobic, resistance, balance, and flexibility exercises. At each session subjects will be informed of the program goals and the methods used to document exercise tolerance of the session's training loads. The quality of the intervention will be measured by patient compliance, adherence, and feedback such as rates of perceived exertion (RPE) which will be documented during the session to measure immediate effect of the intervention. Progressions will be guided by individual responsiveness and measured by RPE. Progressions will be based on the training principles of specificity, adaptability, and overload.

The SarQoL is a patient-reported outcome measurement (PROM) designed to assess quality of life in individuals aged 65 years and older who have been diagnosed with sarcopenia. It is a self-administered questionnaire including 22 questions, rated on a 4-point Likert scale. It assesses perceived domains such as physical & mental health, fears, and functionality in daily life. Each domain is scored from 0-100 and an Overall Score is calculated. The total scoring ranges from 0(worst imaginable health) to 100 (best imaginable health).

Prior to the start of the intervention (Week 1), Mid-point of the intervention (Week 4), Following the completion of the Intervention (Week 8)

The FES-I is a tool that was developed to assess self-confidence while performing physical activity in conjunction with a fear of falling.The questionnaire consists of 16 items that assess the physical, social, and functional aspects related to the fear of falling. The FES-I score ranges from 16 (complete absence of fear of falling) to 64 (extreme concern) points.

Prior to the start of the intervention (Week 1), Mid-point of the intervention (Week 4), Following the completion of the Intervention (Week 8)

The SPPB is utilized to measure physical performance in the present study. The SPPB is a valid and reliable tool for assessing lower extremity function and mobility in community-dwelling adults. The SPPB score measures lower extremity functional performance among older adults by assessing chair stand time, gait speed, and standing balance. SPPB scores range from zero (worst performance) to twelve (best performance) possible points.

Prior to the start of the intervention (Week 1), Mid-point of the intervention (Week 4), Following the completion of the Intervention (Week 8)

A hand dynamometer will be used to assess hand grip strength in both upper extremities. The instrument score is calculated in kg (0-90) with a lower score indicating lower hand grip strength and a higher score indicating higher hand grip strength.

Pre-intervention during the screening process, Mid-point of the intervention (Week 4), Following the completion of the Intervention (Week 8)

Post-intervention interviews will be completed after completion of the 8-week intervention by willing subjects to identify drivers, barriers, and satisfaction levels for participants. Interviews will be 15 minutes in length, held in the same area as the intervention, recorded through Zoom communication platform, and then transcribed for qualitative analysis.

Inclusion Criteria: age greater than or equal to 65 years a score greater than 4 on the the Strength, Assistance with walking, Rising from a chair, Climbing stairs and Falls questionnaire (SARC-F) hand grip strength test includes a score of less than 27kg for males and less than 16 kg for females able and willing to provide consent patient of Geisinger 65Forward Scranton clinic Exclusion Criteria: Diagnosis of mild cognitive impairment, neurological disorders, uncontrolled metabolic disease, history of pacemaker or cardiovascular disease or high blood pressure not controlled with medication Previous history of musculoskeletal surgery or injury that could affect mobility Current participation in a structured exercise training program An inability to perform an exercise program independently

American Psychological Association. (2023). Mild cognitive impairment. In APA dictionary of psychology. https://dictionary.apa.org/mild-cognitive-impairment

Beaudart C, Biver E, Reginster JY, Rizzoli R, Rolland Y, Bautmans I, Petermans J, Gillain S, Buckinx F, Dardenne N, Bruyere O. Validation of the SarQoL(R), a specific health-related quality of life questionnaire for Sarcopenia. J Cachexia Sarcopenia Muscle. 2017 Apr;8(2):238-244. doi: 10.1002/jcsm.12149. Epub 2016 Oct 22.

Bohannon RW. Minimal clinically important difference for grip strength: a systematic review. J Phys Ther Sci. 2019 Jan;31(1):75-78. doi: 10.1589/jpts.31.75. Epub 2019 Jan 10.

Chen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, Jang HC, Kang L, Kim M, Kim S, Kojima T, Kuzuya M, Lee JSW, Lee SY, Lee WJ, Lee Y, Liang CK, Lim JY, Lim WS, Peng LN, Sugimoto K, Tanaka T, Won CW, Yamada M, Zhang T, Akishita M, Arai H. Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J Am Med Dir Assoc. 2020 Mar;21(3):300-307.e2. doi: 10.1016/j.jamda.2019.12.012. Epub 2020 Feb 4.

Cruz-Jentoft, A.J., Bahat, G., Bauer, J., Boirie, Y., Bruyere, O., Cederholm, T., Cooper, C., Landi, F., Rolland, Y., Sayer, A.A., Schneider, S.M., Sieber, C.C., Topinkova, E., Vandwoude, M., Visser, M., Zamboni, M.,.the Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), & the Extended Group for EWGSOP2. (2019). Sarcopenia: revised European consensus on definition and diagnosis. Age and Ageing, 48,16-31. https://doi.org/10.1093/ageing/afy169

de Fatima Ribeiro Silva C, Ohara DG, Matos AP, Pinto ACPN, Pegorari MS. Short Physical Performance Battery as a Measure of Physical Performance and Mortality Predictor in Older Adults: A Comprehensive Literature Review. Int J Environ Res Public Health. 2021 Oct 10;18(20):10612. doi: 10.3390/ijerph182010612.

Delbaere K, Close JC, Mikolaizak AS, Sachdev PS, Brodaty H, Lord SR. The Falls Efficacy Scale International (FES-I). A comprehensive longitudinal validation study. Age Ageing. 2010 Mar;39(2):210-6. doi: 10.1093/ageing/afp225. Epub 2010 Jan 8.

de Mello RGB, Dalla Corte RR, Gioscia J, Moriguchi EH. Effects of Physical Exercise Programs on Sarcopenia Management, Dynapenia, and Physical Performance in the Elderly: A Systematic Review of Randomized Clinical Trials. J Aging Res. 2019 Nov 20;2019:1959486. doi: 10.1155/2019/1959486. eCollection 2019.

Dismore L, Hurst C, Sayer AA, Stevenson E, Aspray T, Granic A. Study of the Older Adults' Motivators and Barriers Engaging in a Nutrition and Resistance Exercise Intervention for Sarcopenia: An Embedded Qualitative Project in the MIlkMAN Pilot Study. Gerontol Geriatr Med. 2020 May 19;6:2333721420920398. doi: 10.1177/2333721420920398. eCollection 2020 Jan-Dec.

Fielding RA, Rejeski WJ, Blair S, Church T, Espeland MA, Gill TM, Guralnik JM, Hsu FC, Katula J, King AC, Kritchevsky SB, McDermott MM, Miller ME, Nayfield S, Newman AB, Williamson JD, Bonds D, Romashkan S, Hadley E, Pahor M; LIFE Research Group. The Lifestyle Interventions and Independence for Elders Study: design and methods. J Gerontol A Biol Sci Med Sci. 2011 Nov;66(11):1226-37. doi: 10.1093/gerona/glr123. Epub 2011 Aug 8.

Geerinck A, Alekna V, Beaudart C, Bautmans I, Cooper C, De Souza Orlandi F, Konstantynowicz J, Montero-Errasquin B, Topinkova E, Tsekoura M, Reginster JY, Bruyere O. Standard error of measurement and smallest detectable change of the Sarcopenia Quality of Life (SarQoL) questionnaire: An analysis of subjects from 9 validation studies. PLoS One. 2019 Apr 29;14(4):e0216065. doi: 10.1371/journal.pone.0216065. eCollection 2019.

Geriatrics. American Physical Therapy Association (APTA). (2021). Outcome measure toolkit for geriatric fall/balance assessment. https://www.aptageriatrics.org/special-interest-groups/balance-falls/Outcome-Measure-Toolkit/Outcome%20Measures%20Toolkit%202020.pdf

Hecksteden A, Faude O, Meyer T, Donath L. How to Construct, Conduct and Analyze an Exercise Training Study? Front Physiol. 2018 Jul 26;9:1007. doi: 10.3389/fphys.2018.01007. eCollection 2018.

Jenkins NDM, Cramer JT. Reliability and Minimum Detectable Change for Common Clinical Physical Function Tests in Sarcopenic Men and Women. J Am Geriatr Soc. 2017 Apr;65(4):839-846. doi: 10.1111/jgs.14769. Epub 2017 Mar 15.

Kaushal N, Langlois F, Desjardins-Crepeau L, Hagger MS, Bherer L. Investigating dose-response effects of multimodal exercise programs on health-related quality of life in older adults. Clin Interv Aging. 2019 Jan 24;14:209-217. doi: 10.2147/CIA.S187534. eCollection 2019.

Kumar P, Umakanth S, Girish N. A review of the components of exercise prescription for sarcopenic older adults. Eur Geriatr Med. 2022 Dec;13(6):1245-1280. doi: 10.1007/s41999-022-00693-7. Epub 2022 Sep 2. Erratum In: Eur Geriatr Med. 2023 Aug 4;:

Thompson PD, Arena R, Riebe D, Pescatello LS; American College of Sports Medicine. ACSM's new preparticipation health screening recommendations from ACSM's guidelines for exercise testing and prescription, ninth edition. Curr Sports Med Rep. 2013 Jul-Aug;12(4):215-7. doi: 10.1249/JSR.0b013e31829a68cf. No abstract available.

Makizako H, Nakai Y, Tomioka K, Taniguchi Y, Sato N, Wada A, Kiyama R, Tsutsumimoto K, Ohishi M, Kiuchi Y, Kubozono T, Takenaka T. Effects of a Multicomponent Exercise Program in Physical Function and Muscle Mass in Sarcopenic/Pre-Sarcopenic Adults. J Clin Med. 2020 May 8;9(5):1386. doi: 10.3390/jcm9051386.

Malmstrom TK, Miller DK, Simonsick EM, Ferrucci L, Morley JE. SARC-F: a symptom score to predict persons with sarcopenia at risk for poor functional outcomes. J Cachexia Sarcopenia Muscle. 2016 Mar;7(1):28-36. doi: 10.1002/jcsm.12048. Epub 2015 Jul 7.

Phu S, Kirk B, Bani Hassan E, Vogrin S, Zanker J, Bernardo S, Duque G. The diagnostic value of the Short Physical Performance Battery for sarcopenia. BMC Geriatr. 2020 Jul 13;20(1):242. doi: 10.1186/s12877-020-01642-4.

Rizzoli R, Reginster JY, Arnal JF, Bautmans I, Beaudart C, Bischoff-Ferrari H, Biver E, Boonen S, Brandi ML, Chines A, Cooper C, Epstein S, Fielding RA, Goodpaster B, Kanis JA, Kaufman JM, Laslop A, Malafarina V, Manas LR, Mitlak BH, Oreffo RO, Petermans J, Reid K, Rolland Y, Sayer AA, Tsouderos Y, Visser M, Bruyere O. Quality of life in sarcopenia and frailty. Calcif Tissue Int. 2013 Aug;93(2):101-20. doi: 10.1007/s00223-013-9758-y. Epub 2013 Jul 5.

Safonova, Y. A. (2020). Sarcopenia risk factor for falls and fractures. The Clinician, 13(3-4), 22-28. https://doi.org/10.17650/1818-8338-2019-13-3-4-22-28

Slade SC, Dionne CE, Underwood M, Buchbinder R. Consensus on Exercise Reporting Template (CERT): Explanation and Elaboration Statement. Br J Sports Med. 2016 Dec;50(23):1428-1437. doi: 10.1136/bjsports-2016-096651. Epub 2016 Oct 5.

Tsekoura M, Billis E, Tsepis E, Dimitriadis Z, Matzaroglou C, Tyllianakis M, Panagiotopoulos E, Gliatis J. The Effects of Group and Home-Based Exercise Programs in Elderly with Sarcopenia: A Randomized Controlled Trial. J Clin Med. 2018 Nov 26;7(12):480. doi: 10.3390/jcm7120480.

U.S. Department of Health & Human Services. (2018). Physical Activity Guidelines for Americans, 2nd edition. https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf

Witham MD. Bridging the gap between the laboratory and the clinic for patients with sarcopenia. Biogerontology. 2019 Apr;20(2):241-248. doi: 10.1007/s10522-018-09793-z. Epub 2018 Dec 27.

Xia L, Zhao R, Wan Q, Wu Y, Zhou Y, Wang Y, Cui Y, Shen X, Wu X. Sarcopenia and adverse health-related outcomes: An umbrella review of meta-analyses of observational studies. Cancer Med. 2020 Nov;9(21):7964-7978. doi: 10.1002/cam4.3428. Epub 2020 Sep 13.