THE EFFECT OF EXERCISE ON MUSCLE MASS AND FUNCTIONAL CAPACITY IN COMMUNITY-DWELLING ELDERLY WITH SARCOPENIA IN JAMAICA

G. Nelson¹, P. Francis-Emmanuel², M. Boyne², T. Forrester³

¹School of Physical Therapy/The University of the West Indies, Kingston, Jamaica, ²Department of Medicine/The University of the West Indies, Kingston, Jamaica, ³Solutions for Developing Countries/The University of the West Indies, Kingston, Jamaica

Background: Sarcopenia is associated with increased risk of falls and disability. No conclusive evidence-based recommendation has been made regarding an effective exercise regimen for elderly persons with sarcopenia. Sarcopenia prevalence in Jamaica is unknown.

Purpose: This study sought to determine 1. muscle mass cut-off points for sarcopenia derived from a Jamaican reference population 2. sarcopenia prevalence among community-dwelling elderly Jamaicans using accepted operational definitions, and 3. the effect of a 6-month combined-modality exercise training on muscle mass and functional capacity in community-dwelling elderly with sarcopenia.

Methods: Data from a convenience sample of healthy Jamaicans aged 18-40 years (N=754, 275 males) were used to identify cut-off points for identifying reduced muscle mass (appendicular lean mass index (ALMI)). Sarcopenia screening of a convenience sample of individuals ≥ 60 years old (N=1344) was conducted by assessing ALMI using dual-energy x-ray absorptiometry, grip strength and walk speed. Descriptive analyses were conducted. Thirty-eight persons with sarcopenia identified using the European Working Group on Sarcopenia in Older Persons (EWGSOP1) participated in a 6-month controlled pilot exercise trial and were randomised to ‘usual care’ non-supervised group (n=19) or to ‘combined-modality’ supervised exercise training group (n=19). A mixed factorial analysis of variance was conducted to compare the effects of the two interventions on ALMI, gait speed, six-minute walk distance, peak oxygen consumption, balance, lower extremity strength, depressive symptoms and activities of daily living.

Results: The Jamaican ALMI cut-off points were 6.9 kg/m² in men and 5.2 kg/m² in women. Prevalence estimates ranged from 3% to 5% depending on operational definition applied. Grip strength was the best predictor of sarcopenia, when compared to walk speed and ALMI. Combined-modality exercise yielded non-significant improvements in muscle mass, gait speed, six-minute walk distance, balance, lower extremity strength and depressive symptoms.

Conclusions: The Jamaican ALMI cut-off points were 6.9 kg/m² in men and 5.2 kg/m² in women. Prevalence estimates were 3%-5% depending on operational definition applied. When compared to walk speed and ALMI, grip strength was the best predictor of sarcopenia. Combined-modality exercise yielded non-significant improvements in muscle mass and functional capacity.

Implications: Sarcopenia prevalence estimates among Jamaican elderly may be lower than that reported globally but comparison with other studies is challenging due to variations in operational definitions of sarcopenia and algorithms for case-finding. This estimate should be applied with caution as a convenience sample was used for sarcopenia screening. In community-dwelling older adults with sarcopenia, combined-modality exercise may improve muscle mass and function. Exercise should be multimodal and specific to the functional deficits encountered in sarcopenia. The population is graying and sarcopenia prevalence is likely to increase in the ensuing years. The presence of sarcopenia increases morbidity, mortality and healthcare costs in affected individuals. Priority should be given to its identification and management in the Jamaican population.

Funding acknowledgements: A USD$9,600 grant was received from the Principal’s New Initiative programme, The University of the West Indies, Mona Campus,

Keywords:
Sarcopenia
Community-dwelling elderly
Exercise

Topics:
Older people
Health promotion & wellbeing/healthy ageing/physical activity
Non-communicable diseases (NCDs) & risk factors

Did this work require ethics approval? Yes

Institution: The University of the West Indies, Mona campus

Committee: Mona Campus Research Ethics Committee

Ethics number: ECP 223, 15/16