Physiotherapy process in individuals with sarcopenia

Abstract

Sarkopenija obuhvaća progresivno smanjenje mišićne mase, a samim time i snage i funkcije. Uzroci sarkopenije primarno se pripisuju starenju, ali postoje i brojni drugi čimbenici koji pridonose njenom razvoju poput neaktivnosti, neadekvatne prehrane ili određenih bolesti. Zbog različitih uzroka, trajanja i težine stanja sarkopenije, razlikujemo više vrsta (primarnu i sekundarnu, akutnu i kroničnu, presarkopeniju, sarkopeniju te tešku sarkopeniju). Dijagnostika obuhvaća suvremene radiološke metode i brojne testove za procjenu mišićne mase, snage i funkcije. Od radioloških metoda, primjenjuju se magnetska rezonanca, računalna tomografija i dvoenergetska rendgenska apsorpciometrija dok fizioterapeuti provode analizu bioelektrične impendancije, mjerenje snage stiska šake i respiratornih mišića, manualni mišićni test, SARC-F upitnik i funkcionalne testove poput šestominutnog testa ili kratkog seta testova fizičke sposobnosti. Prilikom dijagnosticiranja važno je obratiti pozornost na diferencijalnu dijagnozu sarkopenije koja obuhvaća pothranjenost, kaheksiju, krhkost i sarkopenijsku pretilost. Na tijek napredovanja sarkopenije, najviše utječe postavljanje pravovremene dijagnoze. Što se prije dijagnoza postavi, sporije je napredovanje gubitka mišićne mase, snage i funkcije. Takav gubitak narušava kvalitetu života jer osobe gube sigurnost prilikom svakodnevnih aktivnosti što povećava rizik od pada i prijeloma. Upravo iz tih razloga, sarkopenija predstavlja veliki teret za zdravstveni sustav. Integrirani pristup koji uključuje fizioterapiju, prehranu i druge terapijske strategije ključan je za uspješno upravljanje sarkopenijom. Fizioterapeut svojom procjenom, preventivnom i terapijskom intervencijom može pozitivno utjecati na razvoj i napredovanje sarkopenije. S druge strane, pravilna prehrana koja uključuje adekvatan unos kalorija, proteina i drugih nutrijenata također može pozitivno utjecati na prevenciju i liječenje sarkopenije. Cilj integriranog pristupa je ne samo prevenirati ili usporiti napredovanje sarkopenije, već i poboljšati samostalnost, funkcionalnost i kvalitetu života svake osobe oboljele od sarkopenije.Sarcopenia involves a progressive loss of muscle mass, and thus strength and function. The causes of sarcopenia are primarily attributed to aging, but there are also numerous other factors that contribute to its development, such as inactivity, inadequate nutrition, or certain diseases. Due to the different causes, duration, and severity of sarcopenia, we distinguish several types (primary and secondary, acute and chronic, presarcopenia, sarcopenia, and severe sarcopenia). Diagnostics includes modern radiological methods and numerous tests to assess muscle mass, strength, and function. Among radiological methods, magnetic resonance imaging, computed tomography, and dual-energy X-ray absorptiometry are used, while physiotherapists conduct bioelectrical impedance analysis, handgrip and respiratory muscle strength measurements, manual muscle testing, SARC-F questionnaire, and functional tests such as the six-minute test or a short set of physical fitness tests. When diagnosing, it is important to pay attention to the differential diagnosis of sarcopenia, which includes malnutrition, cachexia, frailty and sarcopenic obesity. The course of sarcopenia progression is most influenced by timely diagnosis. The earlier the diagnosis is made, the slower the progression of muscle mass, strength and function loss. Such loss impairs the quality of life because people lose confidence in everyday activities, which increases the risk of falls and fractures. For these reasons, sarcopenia represents a major burden on the healthcare system. An integrated approach that includes physiotherapy, nutrition and other therapeutic strategies is key to the successful management of sarcopenia. A physiotherapist can positively influence the development and progression of sarcopenia through their assessment, preventive and therapeutic intervention. On the other hand, a proper diet that includes an adequate intake of calories, proteins and other nutrients can also positively influence the prevention and treatment of sarcopenia. The goal of an integrated approach is not only to prevent or slow the progression of sarcopenia, but also to improve the independence, functionality and quality of life of every person suffering from sarcopenia