La presente investigación pretende abordar el diseño interactivo como medio de prevención a la sarcopenia, entendida como la pérdida de masa y potencia muscular en personas de la tercera edad. En la actualidad, se ha observado un bajo índice de actividad física en personas de 65 a 80 años. Según un artículo médico de la Universidad Peruana Cayetano Heredia, el porcentaje de adultos mayores con sobrepeso u obesidad en el Perú es de 21,4% y 11,9%, respectivamente (Penny, 2017). El desgaste en la capacidad de los órganos sensoriales son indicios considerables del avance en la adultez mayor. Una de las principales patologías que afecta al adulto mayor, es la disminución de músculo esquelético, el cual es causante de caídas, distensiones, distrofia muscular y enfermedades musculares. Estos factores generan la limitación funcional, pérdida de autonomía e incluso la muerte en el adulto mayor. Igualmente, la presente investigación busca brindar un aporte sólido al rol que desempeña el diseño interactivo en relación a la sarcopenia con el objetivo de prevenir o atenuar dicha patología. En paralelo a esta problemática, existen aplicaciones móviles interactivas enfocadas al diagnóstico de enfermedades primarias, mantener la mente activa y en general, preservar la salud del adulto mayor. Así pues, tras entender la relación de los factores claves en esta investigación, las conclusiones de este proyecto y la investigación del trabajo de campo que analizó a la población objeto de estudio, se propone desarrollar una aplicación móvil llamada Activos. Una solución planteada para promover la actividad física en el adulto mayor y atenuar la sarcopenia. En conclusión, las personas de la tercera edad que utilizaron el aplicativo móvil que se les presentó, argumentaron que es necesario ya que pueden realizar las rutinas de actividad física desde la comodidad de su hogar hasta en el parque. De este modo se beneficiarán, cuidarán su salud y además podrán acceder a posibles descuentos para sus consultas. / The present research aims to address interactive design as a means of prevention of sarcopenia, understood as the loss of muscle mass and power in the elderly. Currently, a low level of physical activity has been observed in people aged 65 to 80 years. According to a medical article from the Universidad Peruana Cayetano Heredia, the percentage of older adults who are overweight or obese in Peru is 21.4% and 11.9%, respectively (Penny, 2017). The wear on the capacity of the sensory organs are considerable indications of the advance in adulthood. One of the main pathologies that affects the elderly is the reduction of skeletal muscle, which is responsible for falls, strains, muscular dystrophy and muscle diseases. These factors generate functional limitation, loss of autonomy and even death in the elderly. Likewise, this research seeks to provide a solid contribution to the role played by interactive design in relation to sarcopenia with the aim of preventing or attenuating this pathology. In parallel to this problem, there are interactive mobile applications focused on the diagnosis of primary diseases, keeping the mind active and, in general, preserving the health of the elderly. Thus, after understanding the relationship of the key factors in this research, the conclusions of this project and the fieldwork research that analyzed the population under study, it is proposed to develop a mobile application called Assets. A solution proposed to promote physical activity in the elderly and attenuate sarcopenia. In conclusion, the elderly people who used the mobile application presented to them, argued that it is necessary since they can perform physical activity routines from the comfort of their home to the park. In this way they will benefit, take care of their health and also have access to possible discounts for their consultations. / Trabajo de investigación

abstract: The purpose of this study was to investigate the Feasibility of Using a Non-Counter Movement Squat to Assess Lower Body Strength in Adults ages 20-70 years. Feasibility was tested by measuring five feasibility metrics described by Bowen et al. (Bowen et al., 2009): Acceptability, Demand, Implementation, Practicality, and Limited Efficacy. Seven male subjects and fifteen female subjects participated in the study. The subjects had their height, weight, body fat percentage by bioelectrical impedance analysis (BIA), and grip strength measured. Subjects performed a warm-up on a cycle ergometer, a Non-Counter Movement Squat Test (NCMST) 1-repetition maximal strength test using a Smith machine, and a cool down on a treadmill. Each subject then completed a post-participation questionnaire used to measure acceptability, Demand was measured by subjects who agreed to participate, implementation was measured by subjects who completed the protocol, practicality was measured by an administrator survey, and limited efficacy was measured by distribution of strength results by age and for all subjects by sex. Results showed acceptance of hypotheses of acceptability, demand, implementation and practicality for both males and females. Limited efficacy was inconclusive for both males and females resulting in rejection of hypothesis. The findings of this study show that further research is needed to compare the NCMST to other lower body muscular strength tests to determine the validity of the NCMST. / Dissertation/Thesis / Masters Thesis Healthcare Innovation 2019

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21258号 / 医博第4376号 / 新制||医||1029(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 松村 由美, 教授 伊達 洋至, 教授 中川 一路 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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Bakgrund   I samhällen där andelen äldre människor ökar i förhållande till andra åldersgrupper, blir det åldersrelaterade sjukdomstillståndet sarkopeni mer och mer aktuellt. Definitionen av sarkopeni innehåller oftast en ökad förlust av muskelmassa och tillståndet har ett tydligt samband med fysiska handikapp, skörhet, längre vårdtider, ökad fallrisk, frakturer, lägre livskvalitet, dödlighet och därmed lidande. Behandling och prevention av sarkopeni innehåller nutritionsrelaterade åtgärder, ofta i form av kosttillskott. För att kunna utföra omvårdnadsåtgärder på ett säkert sätt tillsammans med patienten, är det viktigt att vårdpersonalen har god kunskap som är evidensbaserad. Syfte Syftet var att beskriva effekter av kosttillskott på äldre patienter med sarkopeni. Metod Designen som valdes var en litteraturöversikt. Sexton artiklar hittades genom databassökning och analyserades för att hitta likheter och olikheter mellan dem. Ett resultat sammanställdes genom en integrerad analys. Resultat  Effekterna av kosttillskott på äldre patienter med sarkopeni som hittades kunde delas in i nio olika kategorier: förändring i muskelmassa, kroppsvikt, fysisk kapacitet, fettmassa, fettfri massa, nutritionsstatus, biokemiska parametrar, förekomsten av sarkopeni, samt aktiviteter i det dagliga livet (ADL) och livskvalitet.  Slutsats Effektparametrarna som studerades visade sig ha samband med fenomen som livskvalitet, ADL, fallrisk, vårdtider och dödlighet. Kosttillskottens förmåga att positivt påverka dessa fenomen, kan på det viset spela en betydande roll i lindrande och prevention av lidande bland äldre människor med sarkopeni. / Background Age-related conditions such as sarcopenia are becoming more common in societies where age-distribution is increasingly tilting towards older generations. Sarcopenia, involving increased loss of muscle mass, is significantly associated with physical handicap, frailty, need of medical care, falls, fractures, decreasing quality of life, mortality and suffering. Amongst the methods for treating and preventing sarcopenia are nutrition related interventions such as nutritional supplementation. For nursing and health care to be safe and satisfactory, medical personnel needs to have evidence based knowledge on the applied methods and interventions. Aim The aim was to describe effects of nutritional supplements on elderly patients with sarcopenia. Method The design chosen for this study was a literature review of scientific articles. Sixteen articles were found using databases and analysed with the aim to find similarities and differences. Results The found effects of nutritional supplements on elderly with sarcopenia could be categorized as change in muscle mass, physical capacity, body weight, fat mass, lean body mass, nutritional status, biochemical parameters, the prevalence of sarcopenia as well as activities of daily living (ADL) and quality of life.  Conclusions  The effect parameters defined in the result of this study were shown to be associated with quality of life, ADL, risk for falls, extended need of medical care and mortality. The positive effects of nutritional supplements on these phenomena can therefore play an important role in easing and preventing suffering amongst elderly patients with sarcopenia.

Introduction: Sarcopenia is a disease with a high prevalence in the elderly population and a significant negative impact on quality of life. Physical activity along with adequate nutritional intervention are key to mitigating these effects. Methods: The research was conducted using a questionnaire survey in which 113 nursing homes participated. The quality of nutritional care in these facilities was determined using a survey. Results: A total of 113 nursing homes were included in the research. Of these, 57% of facilities had a registered dietitian available. Nursing homes assess the presence of malnutrition at least 4 times a year in 74% of cases, of which they most often use changes in weight (80 %) and monitoring of food intake (70 %). Only 50 % of the facilities use validated nutritional screening tool. 83 % of the facilities apply nutritional support, most often in the form of diet modification and sipping (98 %). They use food fortifications less often, in a total of 57 % of facilities. The presence of a registered dietitian is affected by the size of the facility, with the larger ones being available to the registered dietitian at a higher frequency. The presence of a registered dietitian in the facility significantly positively affects the frequency of detection of malnutrition (P = 0.039)....

Age-related deficits in muscle mass, strength, and function place an increased burden of work on existing skeletal muscle and may lead to early onset of neuromuscular fatigue (NMF) during activities of daily living. Resistance exercise (RE) is the proven method for improving neuromuscular function in healthy older adults. PURPOSE: To investigate the effects of 6 weeks of RE on the NMF threshold as well as strength and functional performance in older adults. METHODS: Twenty-four older adults were randomly assigned to 6 weeks of RE (EXE; n = 12; age 72 ± 6.3 y; BMI 28.4 kg/m2 ) or control (CONT; n = 12; age 70.3 ± 5.6 y; BMI 27.6 kg/m2 ). Body fat percent (BF%), lean mass (LM), and fat mass (FM) were measured using DEXA and participants performed a discontinuous cycle ergometer test, physical working capacity at fatigue threshold (PWCFT), to determine the onset of NMF. Functional performance was assessed by time to complete 5 chair rises (CHAIR) and walk an 8-foot course (WALK). Lower body strength was assessed by predicted 1-RM leg extension (1RM). Two-way Analysis of Variance (ANOVA; time [PRE, POST] x group [EXE and CONT]) and magnitude based inferences were used to compare dependent variables. RESULTS: RE significantly increased 1RM (35%; p = 0.001) and CHAIR (20%; p = 0.047). RE had a likely beneficial effect on WALK (15%) and a possibly beneficial effect on PWCFT (14%). There were no significant changes to LM or FM, however, women in EXE significantly decreased BF% (p = 0.020). CONCLUSION: Results suggest that RE improves measures of strength and functional performance and possibly the onset of NMF in older adults.

Sarcopenia is a growing health problem in this country as more Americans are living well into old age. It has been thought that a higher protein intake may be related to greater lean muscle mass as well as greater muscular strength and physical functioning. The purpose of this research was to examine protein intake and its relationship to lean body mass and physical functioning in a nationally representative sample of U.S. adults. This research used cross-sectional data from the NHANES 2003-2004 to examine the relationship between protein intake, as an average from two 24h recalls, and dual X-ray absorptiometry (DXA) lean body mass measures. Additionally, these lean body mass measures were examined as predictive of Physical Limitation Score (PLS), an index created from self-reported difficulty in performing basic activities of daily living. Protein intake was examined as total grams of intake, a percentage of total daily energy and as a percent contributed by animal foods. The lean body mass measures used in this analysis included: total lean mass, appendicular lean mass, muscle mass index [lean mass / height (m2)], appendicular lean mass [appendicular lean mass / height (m2)] and percent lean body mass. Questions used to create the self-reported index of functioning, the Physical Limitation Score (PLS), included difficulty in independently: walking ¼ mile, walking up ten stairs without resting, lifting and carrying 10lbs and standing from an armless straight chair. It was found that protein intake significantly, positively predicted lean body mass in select age-gender groups, while more often in men than in women. Total grams of protein intake positively predicted total and appendicular muscle mass index in men ages 19-50 (p-value <0.05), appendicular muscle mass index in men ages 51-70 (p-value 0.038) and percent lean mass in men 71+ years (p-value 0.026). Protein as a percent of energy was a significant, positive predictor of appendicular lean mass in men 19-50 (p-value 0.048), muscle mass index in women 19-50 (p-value 0.007), appendicular muscle mass index in women 19-50 (p-value 0.024) and percent lean mass in men 71+ years (p-value 0.019). Protein as a percent of energy was a significant negative predictor of percent lean mass in older women 71+ years (p-value 0.046). Protein as a percent contributed by animal foods was not a significant predictor of lean mass in any age-gender group. It was also found that Physical Limitation Score (PLS) was surprisingly positively predicted by total and appendicular lean and total and appendicular muscle mass index in nearly all age-gender groups (p-value <0.05) or at least moderately, positively predicted by these (p-value <0.10), meaning that having a greater amount of lean mass predicted greater physical limitation. The only exception was percent lean mass, which was a significant negative predictor of PLS in men and women 60-70 years (p-value <0.05). In this case, a higher percent lean mass was associated with less physical limitation. Additional follow-up analyses revealed that total body fat mass (kg) and percent body fat were significant positive predictors of PLS in most age-gender groups (p-value <0.05), indicating that higher amounts of body fat predicted greater self-reported limitation. Protein expressed as total grams per day or as a percent of total daily energy were generally significant or marginally significant predictors of lean mass in men of all ages but not often in women while protein as a percent contributed by animal foods was not found to be a significant predictor in any age-gender group. Total lean mass, total fat mass and total percent body fat were generally significant positive predictors of physical limitation, calling into question the functional implications of body composition in an older population. Results suggest that in older adults, excess body fat may be a stronger predictor of physical limitation than low lean muscle mass.

<p><strong>Introduction:</strong> Mitochondria are important organelles for skeletal muscle function. Mitochondria are susceptible to many forms of stress that alters their morphology, energy generation and reactive oxygen species (ROS) production, which collectively promote degeneration and dysfunction in skeletal muscle. These processes are implicated in many health disorders, particularly in the aging process itself. Exercise is well established to increase muscle mitochondrial content and thus may attenuate several aspects of mitochondrial deterioration. <strong>Methods:</strong> Both human and animal models of mitochondrial stress (aging, ROS) were utilized in order to determine their effects on mitochondrial and muscle function. Additionally, exercise training was used in order to assess its therapeutic potential in ameliorating defects in oxidative capacity, muscle atrophy and metabolic adaptation in skeletal muscle. <strong>Results:</strong> Aging resulted in reduced strength, aerobic capacity, larger intramyocelluar lipid droplets and fewer mitochondria in skeletal muscle. These changes were related to suppressed lipid metabolism, mitochondrial dynamics and organelle turnover. Habitual aerobic exercise partially attenuated the age-related loss of muscle strength and aerobic capacity, presumably due in part to improved mitochondrial function. Persistent mitochondrial oxidative stress prevented mitochondrial adaptations to exercise training in mice, a phenomenon that may explain why exercise cannot fully counteract the effects of aging in skeletal muscle. <strong>Conclusions and significance:</strong> This work furthers our knowledge of the mitochondrial consequences of aging and the therapeutic potential of aerobic exercise within skeletal muscle. These results can be applied to other differentiated tissues that are severely affected by aging (brain, heart) and the effects described here are likely relevant to other conditions that result in muscle atrophy and energetic insufficiency.</p> / Doctor of Philosophy (PhD)