Exploration Of A Screening Model For Sarcopenia In Suburban Shanghai And Study Of The Intervention Effect Of Low-Intensity Resistance Training Combined With Blood Flow Restriction

Objectives:Sarcopenia,a progressive age-related decay of muscles throughout the body,sarcopenia not only reduces the mobility of elderly patients and increases their risk of osteoporosis,falls,fractures,disability,and loss of self-care,but also leads to a significant increase in the cost of care and medical costs invested by individuals and society,and has a negative impact on socioeconomic development.With the increasing aging of our population,the prevalence of geriatric sarcopenia in China is not optimistic.Studies on Asian populations have shown that the risk of sarcopenia increases by about 6%-12.9% for every 1 year of age increase.Chongming District is the most serious aging area in Shanghai.According to the results of the 2020 Shanghai Census Yearbook,Chongming District became the district with the highest percentage of resident population over 65 years old in Shanghai,reaching 29.63%.Due to its unique geographical environment and demographic characteristics,the aging phenomenon in Chongming District is becoming more and more prominent as the construction of a world-class ecological island continues to advance.The aging population will bring more challenges and difficulties to the public health service system.At present,there is no research study on geriatric sarcopenia in Chongming area.There is also no screening and treatment for senile sarcopenia in local health institutions.Due to the special geographical and ecological environment of Chongming district,the lifestyle,dietary habits and nutritional intake of the elderly population are significantly different from those of other regions,and it is urgent to understand the prevalence of sarcopenia,related risk factors,the best screening modalities and treatment measures in the elderly population in this area.Therefore,the objectives of this study were 1.to investigate the prevalence and risk factors associated with sarcopenia in the elderly in Chongming District;2.to compare the diagnostic performance of SARC-F+EBM,SARC-CALF and SARC-F screening scales for sarcopenia and to explore the most efficient screening modality for sarcopenia;3.to investigate and compare the effects of low-intensity resistance training combined with blood flow restriction and conventional highintensity resistance training on patients with sarcopenia,and to provide a better diagnosis for patients with sarcopenia.To explore and compare the effects of lowintensity resistance training combined with blood flow restriction and conventional high-intensity resistance training on patients with sarcopenia,providing a safe and effective exercise alternative for patients with sarcopenia.Methods:This total study mainly includes three studies: a cross-sectional study of different degrees of sarcopenia,a comparative study of different sarcopenia screening methods,and a study of efficacy of three-arm randomized controlled trial.(1)Study 1: An 8-month cross-sectional study.According to Asia Working Group for Sarcopenia,AWGS(AWGS)2019 standards,the elderly over 65 years old were screened for sarcopenia in 7 communities in 2 towns in Chongming District.Participants were diagnosed as non-sarcopenia,possible sarcopenia,mild to moderate sarcopenia,and severe sarcopenia based on measured muscle mass(ASMI),grip strength,gait speed and 5-time sit-stand tests.A total of 1407 participants were included,including clinical and sociodemographic characteristics,cardiovascular disease risk factors,inflammatory cytokines,physical activity and daily living style activities,to determine the epidemiology of different degrees of sarcopenia,and to explore the risk factors related to sarcopenia and pre-sarcopenia,to provide a theoretical basis for future sarcopenia screening and intervention.(2)Study 2:SARC-F+EBM,SARC-CALF and SARC-F screening scales were used for sarcopenia and pre-sarcopenia screening,comparing the differences in diagnostic efficacy of the three screening methods in the elderly population,and exploring the most efficient screening method for the elderly in this area;Develop a sarcopenia screening and management APP,mainly includes rapid screening of sarcopenia,specific exercise plans,sarcopenia treatment consultation,common health knowledge of sarcopenia,to provide advice and services for the prevention and treatment of sarcopenia.(3)Study 3:A 12-week three-arm randomized controlled trial.Forty-five community elderly people over 65 years old were randomly divided into low-intensity resistance training combined with blood flow restriction group(LRT-BFR,n=15),traditional highintensity resistance training group(CRT,n=15),and control group(n=15).LRT-BFR group and CRT group receive exercise interventions three times a week for 12 weeks,with the LRT-BFR group receiving low-intensity resistance training under blood flow blockade(20%-30%1RM)and the CRT group receiving conventional high-intensity resistance training(60%-70%1RM).Resistance training uses different colors of elastic bands called“Thera-band”.The control group did not carry out exercise interventions,but only received health education.Muscle mass(ASMI),muscle strength(grip and lower extremity strength),physical performance(gait speed),risk factors associated with sarcopenia(depression,body fat percentage,neutrophil-to-lymphocyte ratio[NLR],and platelet-to-lymphocyte ratio[PLR]),cardiovascular disease risk factors(blood pressure,glucose,and lipids),and blood biomarkers(inflammatory cytokines,hormones,and growth factors)were assessed as outcomes.Results:(1)The results of the cross-sectional study(Study 1)showed that.The overall prevalence of sarcopenia was 19.6%(17.1% in females and 23.1% in males).The prevalence of possible sarcopenia,mild to moderate sarcopenia,and severe sarcopenia was 19.7%(22.2% for women and 16.2% for men),11.9%(10.1% for women and 14.5% for men),and 7.7%(7% for women and 8.6% for men),respectively.In all subjects,factors such as 75 years and older,male,depressive status and high body fat percentage increased the risk of sarcopenia.In women,living alone and high body fat increased the likelihood of developing sarcopenia,and high BMI,high body weight,and increased time spent doing housework decreased the likelihood of developing sarcopenia;in male,depressive status,high body fat percentage,and high NLR increased the likelihood of developing sarcopenia,and high BMI and body weight decreased the likelihood of developing sarcopenia.Possible sarcopenia was associated with age 75 years and older,high waist circumference and high PLR values,and was negatively associated with NLR values.High levels of physical activity were effective in reducing the prevalence of sarcopenia,which decreased significantly with increasing physical activity.(2)The results of the exploration of different screening modalities for myasthenia gravis(Study 2 showed that.1)Detection rates of possible sarcopenia and sarcopeniaThe SARC-CALF screening scale had the highest detection rates of possible sarcopenia and myasthenia sarcopenia(59.2% and 44%),with the detection rate of possible sarcopenia significantly higher than that of SARC-F+EBM and SARC-F screening scales(p<0.01)and the detection rate of sarcopenia significantly higher than that of SARC-F screening scale(p<0.01);the next highest was the SARC-F+EBM The next highest was the SARC-F+EBM screening scale,in which the detection rates of possible sarcopenia and sarcopenia were 38.3%and 37.5%,respectively,both of which were significantly higher than those of the SARC-F screening scale(p<0.01);the detection rates of anterior sarcopenia and sarcopenia in the SARC-F screening scale were the lowest,at 11.6%and 8%,respectively.2)Screening for sarcopeniaThe sensitivity of the SARC-CALF screening scale for screening sarcopenia was the highest,89.5%,and the sensitivities of the SARC-F+EBM and SARC-F screening scales were 73.1% and 48.7%,respectively;the specificity of the SARC-F+EBM screening scale was the highest,74.8%,and the specificities of the SARC-CALF and SARC-F screening scales for screening sarcopenia.The positive likelihood ratios for the SARC-F+EBM,SARC-CALF and SARC-F screening scales were 2.89,2.71 and 1.87,respectively;the negative likelihood ratios were 0.36,0.16 and 0.69,respectively.The SARC-CALF screen for sarcopenia had the highest AUC value of 0.812(0.788-0.835),a Jorden index of 0.565,and an optimal cutoff value of >4.The SARCF+EBM scale had an AUC value of 0.789(0.764-0.813),a Jorden index of 0.478,and an optimal cutoff value of >2.The SARC-F screen for sarcopenia,The SARC-F screening scale for sarcopenia had the lowest AUC value of 0.632(0.603-0.660),a Yordon index of 0.227,and an optimal cutoff value of >0.Compared with the SARC-F screening scale,the SARC-F+EBM screening scale had a higher AUC value of 0.157(0.123-0.192),with a significant difference(p<0.0001);the SARC-CALF screening scale had a higher AUC value of 0.180(0.151-0.21),with a significant difference(p<0.0001).The AUC value of the SARC-CALF screening scale was 0.023(-0.010-0.056)higher compared to the SARC-F+EBM screening scale,and the difference was not significant(p=0.17).3)Screening for possible sarcopeniaThe sensitivity of the SARC-CALF screening scale for screening possible sarcopenia was the highest,67.2%,and the sensitivities of the SARC-F+EBM and SARC-F screening scales were 52% and 49.5%,respectively;the specificity of the SARC-F+EBM screening scale was the highest,74.7%,and the specificities of the SARC-CALF and SARC-F screening scales were The positive likelihood ratios for the SARC-F+EBM,SARC-CALF and SARC-F screening scales were 2.06,1.42 and 1.90,respectively;the negative likelihood ratios were 0.64,0.62 and 0.68,respectively.The SARC-F+EBM scale had the highest AUC value of 0.664(0.636-0.691),with a Jorden index of 0.267 and an optimal cutoff value of >2.The SARC-F had an AUC value of 0.633(0.604-0.661),with a Jorden index of 0.234 and an optimal cutoff value of >0.The SARC-CALF had the lowest AUC value of 0.607(0.578-0.636),with a Yordon index of 0.20 and an optimal cut-off value of >0.Compared with the SARC-F screening scale,the SARC-F+EBM screening scale had a higher AUC value of 0.031(0.001-0.061),with a significant difference(p=0.04);the SARC-CALF screening scale had a higher AUC value of 0.025(-0.006-0.057),the difference was not significant(p=0.12).The AUC value of the SARC-CALF screening scale was 0.057(0.018-0.009)higher compared to the SARC-F+EBM screening scale,with a significant difference(p=0.004).(3)The results of the three-arm randomized controlled trial(Study 3)showed that.1)Clinical indicatorsA significant increase in lower limb muscle strength(Δ=1.22±1.79,p=0.02),gait speed(Δ=1.22±1.79,p=0.10)and ASMI(Δ=0.23±0.21,p=0.006)and a significant decrease in depressive symptoms(Δ=-0.87±1.36,p=0.03)in subjects in the LRT-BFR group after 12 weeks of exercise intervention;Subjects in the CRT group had significantly increased grip strength(Δ=2.15±3.00,p=0.024),lower extremity muscle strength(Δ=1.22±1.79,p=0.001),gait speed(Δ=1.22±1.79,p<0.001)and ASMI(Δ=0.23±0.21,p=0.07)and significantly increased body fat percentage(Δ=-2.08±3.98,p=0.03),depressive symptoms(Δ=-0.82±1.64,p=0.03)and waist circumference(Δ=-0.50±1.07,p=0.03)were significantly decreased;no significant changes were observed in the control subjects.Compared with the amount of change in the control group,the amount of change in body weight(Δ=1.22±1.79,p=0.03),BMI(Δ=0.49±0.73,p=0.02),ASMI(Δ=0.23±0.21,p=0.03),and lower limb muscle strength(Δ=4.36±3.84,p=0.03)were significantly increased in the LRT-BFR group,and in the CRT group The amount of changes in ASMI(Δ=0.63±0.74,p=0.03),lower limb muscle strength(Δ=5.61±4.93,p=0.002),and gait speed(Δ=0.14±0.04,p=0.001)were significantly increased in the CRT group;the amount of changes in body fat percentage(Δ=0.14±0.04,p=0.02)was significantly higher than in the LRT-BFR group;2)Cardiovascular disease risk factorsAfter 12 weeks of exercise intervention,total cholesterol(Δ =-0.20 ± 0.26,p=0.02),heart rate(Δ=7.00±16.41,p=0.01),and HDL(Δ=0.27±0.33,p=0.03)were significantly improved in the LRT-BFR group;subjects in the CRT group had significantly better heart rate(Δ=-12.62±16.55,p= 0.001),fasting glucose(Δ=-0.20±0.30,p=0.001),and cholesterol significantly improved(Δ=-0.15±0.22,p=0.001);Compared to the amount of change in the control group,the amount of change in cholesterol(Δ=-0.20±0.26,p=0.03),triglycerides(Δ=-0.51±0.38,p=0.001),and HDL(Δ=0.27±0.33,p=0.004)were significantly improved in the LRT-BFR group;triglycerides(Δ=-0.20±0.26,p = 0.01)were significantly reduced;3)Blood biomarkers for sarcopeniaAfter 12 weeks of exercise intervention,tumor necrosis factor alpha(Δ=-3.27±4.36,p=0.04),muscle growth inhibitor(Δ=-0.42±0.49,p=0.03),and insulin-like growth factor(Δ=6.27±10.52,p=0.04)were significantly improved in the LRT-BFR group;subjects in the CRT group had a significant improvement in tumor necrosis factor alpha(Δ=-4.52±7.88,p=0.03),muscle growth inhibitor(Δ=-0.40±0.49,p=0.04),insulin-like growth factor(Δ=15.08±9.74,p<0.001),follicle inhibitor(Δ=1.27 ± 1.24,p=0.002),and lipocalin(Δ =5.44 ± 0.07,p=0.04)significantly improvement;Compared with the amount of change in the control group,the amount of change in insulin-like growth factor(Δ=6.27±10.52,p=0.04)and muscle growth inhibitor was significantly lower in the LRT-BFR group(Δ =-0.42 ± 0.49,p=0.01);tumor necrosis factor α(Δ=-4.52±7.88,p=0.03)and muscle growth inhibitor(Δ=-0.40±0.49,p=0.01),insulin-like growth factor(Δ=15.08±9.74,p<0.001),follicle inhibitor(Δ=1.27±1.24,p=0.001),and lipocalin(Δ=5.44±0.07,p=0.04)were significantly improved in the CRT group;the amount of change in insulin-like growth factor was significant in the CRT group(Δ= 15.08±9.74,p=0.01)was higher than that of the LRT-BFR group.Conclusion:The prevalence of sarcopenia in the elderly in Chongming area is high,especially in elderly(over 75 years old)and male,and increasing physical activity can help to reduce the prevalence and delay the progression of sarcopenia.Community health workers should pay special attention to older adults with low weight and BMI,high waist circumference,depression,high PLR values,low NLR values,living alone,not doing housework or working long hours in agriculture,and should screen for sarcopenia early to reduce the occurrence of risk factors associated with sarcopenia.On the other hand,routine screening for sarcopenia should also be performed for timely intervention to reduce the risk of its adverse events.Both the SARC-CALF and SARC-F+EBM screening scales significantly improved the sensitivity and accuracy of the SARC-F screening scale,and both had similar diagnostic performance for sarcopenia.Although both had lower diagnostic performance for pre-screening sarcopenia,SARC-F+EBM appeared to exert higher diagnostic performance.Therefore,both SARC-F+EBM and SARC-CALF screening scales can be used in screening for community-based sarcopenia in this region,and for screening for possible sarcopenia,SARC-F+EBM can be preferred.Both LRT-BFR and CRT are safe and effective in older people with sarcopenia.Compared to LRT-BFR,CRT plays a better role in improving the progression of sarcopenia.CRT can be preferred for older people who want to make significant improvements in muscle strength and physical performance,and LRT-BFR can be an alternative resistance training method for older people with sarcopenia who are unable to perform high-intensity resistance training.