Fragilidade : prevalência, fatores associados e tratamento através do treinamento de força

Orientadores: Marco Carlos Uchida, Bruno RodriguesTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Educação FísicaResumo: A fragilidade é um estado potencialmente reversível de maior vulnerabilidade à desfechos de saúde negativos, o qual ocorre como resultado do comprometimento biológico multissistêmico e aspectos socioambientais. A prevalência de fragilidade na Europa e na Ásia já foi estabelecida e, mais recentemente, pesquisadores sugeriram que a incidência de fragilidade em três anos ao rendo do mundo é de 13,6%. Embora os países da América do Sul sejam uma economia emergente, ainda sofrem com a pobreza, desnutrição, moradia precária, falta de informação e baixa qualidade de vida, todas variáveis associadas ao desenvolvimento da fragilidade. No entanto, a prevalência de fragilidade na América do Sul ainda é pouco explorada. Portanto, o presente projeto de doutorado investigou a prevalência de fragilidade na América do Sul. A gênese e a progressão da fragilidade estão associadas à muitos desfechos negativos relacionados à saúde, como limitações da mobilidade e anormalidades cardiovasculares. Em contraste, o alto consumo proteico parece estar associado negativamente ao status de fragilidade. Notavelmente, a definição operacional de fragilidade ainda é difícil pela ausência de uma definição unívoca, e mais de 60 instrumentos diferentes para a sua avaliação estão atualmente disponíveis. Algumas investigações observaram que esses instrumentos não capturam necessariamente o mesmo construto, o que permite supor que a associação entre fragilidade e outros fatores possa ser dependente do instrumento utilizado. Com base nessas premissas, este projeto investigou a relação entre o status de fragilidade e a ingestão de proteínas, função física e parâmetros relacionados à hipertensão arterial sistêmica usando 4 instrumentos diferentes. O estabelecimento da fragilidade como um problema de saúde pública levou pesquisadores a examinar terapias para colaborar com o tratamento dessa condição. Muita atenção tem sido dada ao exercício físico, principalmente ao treinamento de força (TF), dados os inúmeros estudos que relataram melhorias nos parâmetros relacionados à fragilidade em resposta aos programas de TF. No entanto, mesmo que os programas tradicionais de TF, ou também chamados treinamento de resistência a baixa velocidade (LSRT), pareçam ser uma ferramenta poderosa para melhorar a força muscular, seus efeitos da mobilidade são menos pronunciados. Nesse contexto, evidências que a potência muscular, a capacidade de exercer força em um curto intervalo de tempo, diminui precocemente e está mais associada à tarefas de mobilidade do que a força muscular, levou à suposição de que os protocolos de RT de alta velocidade (HSRT) poderiam causar maiores melhorias na mobilidade do que o LSRT. Ensaios clínicos randomizados, revisões sistemáticas e 11 metanálises testaram essa hipótese e os resultados ainda são controversos. Além disso, as investigações são baseadas em idosos robustos, de modo que os efeitos dos programas de TF no status de fragilidade e no desempenho físico de idosos frágeis não foram descritos anteriormente. Assim, o presente projeto investigou os efeitos do HSRT e LSRT no status de fragilidade. Secundariamente, foi examinado os efeitos de ambos os programas de TF no desempenho físico, função cognitiva e pressão arterial, dada sua estreita associação com à fragilidadeAbstract:DoutoradoAtividade Fisica AdaptadaDoutor em Educação Física01P-1870/2016, 23P-6076/2018CAPE

Age- and Sex-Specific Normative Values for Muscle Mass Parameters in 18,625 Brazilian Adults.

Background: The present study aimed to provide age- and sex-specific normative values for muscle mass parameters in Brazilian adults. Methods: Data pertaining to Brazilian adults (18+ years) who attended a nutritional clinical between January 2018 and July 2022 were analyzed. Muscle mass parameters were assessed using a bioimpedance digital scale (InBody 230, GBC BioMed NZ). Assessments were conducted under standard conditions, with participants refraining from physical exercise for 96 h and from eating or drinking (including water) for 8 h before evaluations. Results: A total of 18,625 Brazilian adults were analyzed. Normative values for absolute and relative (height, m2) muscle mass and appendicular muscle mass (ASM) were calculated. In addition, specific age-related changes in muscle mass parameters were observed. In women, muscle mass peaked between the ages of 40–49 before gradually declining at an average rate of 5.7% per decade from the sixth decade of life onwards. ASM reached its peak earlier, during the third decade of life, and started to decline later, from 50 to 59 years. In contrast, absolute and ASM peaked at 40–49 years and declined from the sixth decade of life in men. Both sexes displayed a slightly greater decline in ASM than in muscle mass (13 vs. 12%). Conclusions: The present study provides normative values for absolute and relative muscle mass and ASM in Brazilian adults. Furthermore, important specific age-related changes in muscle mass parameters were observed. These data have public health implications and might serve as a reference tool to guide health professionals

Mitophagy: At the heart of mitochondrial quality control in cardiac aging and frailty

Cardiovascular disease is highly prevalent among older adults and poses a huge burden on morbidity, disability, and mortality. The age-related increased vulnerability of the cardiovascular system towards stressors is a pathophysiological trait of cardiovascular disease. This has been associated with a progressive deterioration of blood vessels and decline in heart function during aging. Cardiomyocytes rely mostly on oxidative metabolism for deploying their activities and mitochondrial metabolism is crucial to this purpose. Dysmorphic, inefficient, and oxidant-producing mitochondria have been identified in aged cardiomyocytes in association with cardiac structural and functional alterations. These aberrant organelles are thought to arise from inefficient mitochondrial quality control, which has therefore been place in the spotlight as a relevant mechanism of cardiac aging. As a result of alterations in mitochondrial quality control and redox dyshomeostasis, mitochondrial damage accumulates and contributes to cardiac frailty. Herein, we discuss the contribution of defective mitochondrial quality control pathways to cardiac frailty. Emerging findings pointing towards the exploitation of these pathways as therapeutic targets against cardiac aging and cardiovascular disease will also be illustrated

Age- and sex-specific normative values for muscle mass parameters in 18,625 Brazilian adults

BackgroundThe present study aimed to provide age- and sex-specific normative values for muscle mass parameters in Brazilian adults.MethodsData pertaining to Brazilian adults (18+ years) who attended a nutritional clinical between January 2018 and July 2022 were analyzed. Muscle mass parameters were assessed using a bioimpedance digital scale (InBody 230, GBC BioMed NZ). Assessments were conducted under standard conditions, with participants refraining from physical exercise for 96 h and from eating or drinking (including water) for 8 h before evaluations.ResultsA total of 18,625 Brazilian adults were analyzed. Normative values for absolute and relative (height, m2) muscle mass and appendicular muscle mass (ASM) were calculated. In addition, specific age-related changes in muscle mass parameters were observed. In women, muscle mass peaked between the ages of 40–49 before gradually declining at an average rate of 5.7% per decade from the sixth decade of life onwards. ASM reached its peak earlier, during the third decade of life, and started to decline later, from 50 to 59 years. In contrast, absolute and ASM peaked at 40–49 years and declined from the sixth decade of life in men. Both sexes displayed a slightly greater decline in ASM than in muscle mass (13 vs. 12%).ConclusionsThe present study provides normative values for absolute and relative muscle mass and ASM in Brazilian adults. Furthermore, important specific age-related changes in muscle mass parameters were observed. These data have public health implications and might serve as a reference tool to guide health professionals

Protein Intake and Cognitive Function in Older Adults: A Systematic Review and Meta-Analysis

Introduction: The present study investigated the association between protein intake and cognitive function in older adults.Methods: We performed a literature search with no restriction on publication year in MEDLINE, SCOPUS, CINAHL, Age-Line from inception up to October 2020. Observational studies that investigated as a primary or secondary outcome the association of protein intake and cognitive function in older adults aged >= 60 years were included.Results : Nine cross-sectional studies that investigated a total of 4929 older adults were included in the qualitative analysis. Overall cognitive function was examined in 6 studies. Four investigations reported null associations and 2 studies found that older adults with a high protein intake had higher global cognitive function than their counterparts. Results from the meta-analysis suggested that there were no significant associations between protein consumption and global cognitive function in older adults, regardless of gender. Three studies investigated other cognitive domains. Memory and protein intake were significantly and positively correlated in all studies. In addition, visuospatial, verbal fluency, processing speed, and sustained attention were positively associated with protein consumption in 1 study each.Conclusion: No significant associations between protein intake and global cognitive function were observed in neither qualitative nor quantitative analyses. The association between protein consumption with multiple other cognitive domains were also tested. As a whole, 3 studies reported a positive and significant association between high protein intake and memory, while 1 study observed a significant and positive association with visuospatial, verbal fluency, processing speed, and sustained attention

The COVID-19 Pandemic and Physical Activity

The SARS-CoV-2-caused COVID-19 pandemic has resulted in a devastating threat to human society in terms of health, economy, and lifestyle. Although the virus usually first invades and infects the lung and respiratory track tissue, in extreme cases, almost all major organs in the body are now known to be negatively impacted often leading to severe systemic failure in some people. Unfortunately, there is currently no effective treatment for this disease. Pre-existing pathological conditions or comorbidities such as age are a major reason for premature death and increased morbidity and mortality. The immobilization due to hospitalization and bed rest and the physical inactivity due to sustained quarantine and social distancing can downregulate the ability of organs systems to resist to viral infection and increase the risk of damage to the immune, respiratory, cardiovascular, musculoskeletal systems and the brain. The cellular mechanisms and danger of this "second wave" effect of COVID-19 to the human body, along with the effects of aging, proper nutrition, and regular physical activity, are reviewed in this editorial article

Acute effects of physical exercise in type 2 diabetes: A review

Abstract The literature has shown the efficiency of exercise in the control of type 2 diabetes (T2D), being suggested as one of the best kinds of non-pharmacological treatments for its population. Thus, the scientific production related to this phenomenon has growing exponentially. However, despite its advances, still there is a lack of studies that have carried out a review on the acute effects of physical exercise on metabolic and hemodynamic markers and possible control mechanisms of these indicators in individuals with T2D, not to mention that in a related way, these themes have been very little studied today. Therefore, the aim of this study was to organize and analyze the current scientific production about the acute effects of physical exercise on metabolic and hemodynamic markers and possible control mechanisms of these indicators in T2D individuals. For such, a research with the following keywords was performed: -exercise; diabetes and post-exercise hypotension; diabetes and excess post-exercise oxygen consumption; diabetes and acute effects in PUBMED, SCIELO and HIGHWIRE databases. From the analyzed studies, it is possible to conclude that, a single exercise session can promote an increase in the bioavailability of nitric oxide and elicit decreases in postexercise blood pressure. Furthermore, the metabolic stress from physical exercise can increase the oxidation of carbohydrate during the exercise and keep it, in high levels, the post exercise consumption of O², this phenomenon increases the rate of fat oxidation during recovery periods after exercise, improves glucose tolerance and insulin sensitivity and reduces glycemia between 2-72 h, which seems to be dependent on the exercise intensity and duration of the effort. Key words: Metabolic diseases; Hypertension; Nitric oxide; Blood glucose; Oxygen consumption Core tip: Physical exercise is one of the best kinds of non-pharmacological treatments to prevent and control type 2 diabetes (T2D), being recommended by important medical associations, such as American College of Sports Medicine and the American Diabetes Association. In the literature, studies about the effects of a single exercise session on the population, its changes in blood pressure, glycemia, carbohydrate oxidation, fat oxidation, increase in nitric oxide and others are increasing exponentially. In this review, we report the most recent and important findings in the literature about the ef- REVIEW Submit

Metabolites

An altered amino acid metabolism has been described in frail older adults which may contribute to muscle loss and functional decline associated with frailty. In the present investigation, we compared circulating amino acid profiles of older adults with physical frailty and sarcopenia (PF&S, = 94), frail/pre-frail older adults with type 2 diabetes mellitus (F-T2DM, = 66), and robust non-diabetic controls ( = 40). Partial least squares discriminant analysis (PLS-DA) models were built to define the amino acid signatures associated with the different frailty phenotypes. PLS-DA allowed correct classification of participants with 78.2 ± 1.9% accuracy. Older adults with F-T2DM showed an amino acid profile characterized by higher levels of 3-methylhistidine, alanine, arginine, ethanolamine, and glutamic acid. PF&S and control participants were discriminated based on serum concentrations of aminoadipic acid, aspartate, citrulline, cystine, taurine, and tryptophan. These findings suggest that different types of frailty may be characterized by distinct metabolic perturbations. Amino acid profiling may therefore serve as a valuable tool for frailty biomarker discovery