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Sarcopenia and Physical Function in Middle-Aged and Older Stroke Survivors

  • Alice S. Ryan
    Correspondence
    Corresponding author Alice S. Ryan, PhD, Division of Gerontology and Geriatric Medicine, BT/18/GR, 10 N Greene St BVAMC, Baltimore, MD 21201.
    Affiliations
    Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, MD

    Baltimore Veterans Administration Maryland Health Care System Geriatric Research, Education and Clinical Center, Baltimore, MD

    Maryland Exercise and Robotics Center of Excellence, Baltimore, MD
    Search for articles by this author
  • Frederick M. Ivey
    Affiliations
    Department of Neurology, University of Maryland School of Medicine, Baltimore, MD

    Baltimore Veterans Administration Maryland Health Care System Geriatric Research, Education and Clinical Center, Baltimore, MD

    Maryland Exercise and Robotics Center of Excellence, Baltimore, MD
    Search for articles by this author
  • Monica C. Serra
    Affiliations
    Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, MD

    Baltimore Veterans Administration Maryland Health Care System Geriatric Research, Education and Clinical Center, Baltimore, MD

    Maryland Exercise and Robotics Center of Excellence, Baltimore, MD
    Search for articles by this author
  • Joseph Hartstein
    Affiliations
    Department of Medicine, Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore, MD

    Baltimore Veterans Administration Maryland Health Care System Geriatric Research, Education and Clinical Center, Baltimore, MD

    Maryland Exercise and Robotics Center of Excellence, Baltimore, MD
    Search for articles by this author
  • Charlene E. Hafer-Macko
    Affiliations
    Department of Neurology, University of Maryland School of Medicine, Baltimore, MD

    Baltimore Veterans Administration Maryland Health Care System Geriatric Research, Education and Clinical Center, Baltimore, MD

    Maryland Exercise and Robotics Center of Excellence, Baltimore, MD
    Search for articles by this author
Published:August 13, 2016DOI:https://doi.org/10.1016/j.apmr.2016.07.015

      Abstract

      Objectives

      To determine the prevalence of sarcopenia in stroke survivors using different methodologies, and compare a subset of the stroke group to age-, sex-, and body mass index (BMI)-matched nonstroke control counterparts.

      Design

      Cohort study.

      Setting

      A Veterans Affairs medical center and a university hospital.

      Participants

      Mild to moderately disabled participants >6 months after onset of stroke aged 40 to 84 years (N=190, 61% men, 57% African American; mean BMI ± SEM, 29±1kg/m2).

      Interventions

      Not applicable.

      Main Outcome Measures

      Dual-energy x-ray absorptiometry scans to assess appendicular lean mass (ALM). Rates of sarcopenia were determined using 4 established methods: (1) ALM/height2 (ALM/ht2); (2) European Working Group on Sarcopenia in Older Persons; (3) International Working Group on Sarcopenia; and (4) ALM/BMI.

      Results

      Sarcopenia prevalence in our stroke cohort ranged between 14% and 18%. The stroke survivor subset (n=38) matched one-for-one with control counterparts for race, sex, age ±4 years and BMI ±2.5kg/m2 had higher prevalence rates compared with their nonstroke counterparts (13.2% vs 5.3%, P<.0001). ALM/ht2 was related to 6-minute walking speed (r=.28, P<.01) and peak oxygen consumption (L/min: r=.58, P<.0001) for the stroke group.

      Conclusions

      Stroke survivors show an elevated prevalence of sarcopenia when considering age, sex, and race compared with nonstroke individuals.

      Keywords

      List of abbreviations:

      ALM (appendicular lean mass), BMI (body mass index), DXA (dual-energy x-ray absorptiometry), EWGSOP (European Working Group on Sarcopenia in Older Persons), ht (height), IWG (International Working Group on Sarcopenia), Vo2peak (peak oxygen consumption)
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      References

        • Ovbiagele B.
        • Goldstein L.B.
        • Higashida R.T.
        • et al.
        Forecasting the future of stroke in the United States: a policy statement from the American Heart Association and American Stroke Association.
        Stroke. 2013; 44: 2361-2375
        • Kelly-Hayes M.
        • Beiser A.
        • Kase C.S.
        • Scaramucci A.
        • D'Agostino R.B.
        • Wolf P.A.
        The influence of gender and age on disability following ischemic stroke: the Framingham study.
        J Stroke Cerebrovasc Dis. 2003; 12: 119-126
        • Ryan A.S.
        • Dobrovolny C.L.
        • Smith G.V.
        • Silver K.H.
        • Macko R.F.
        Hemiparetic muscle atrophy and increased intramuscular fat in stroke patients.
        Arch Phys Med Rehabil. 2002; 83: 1703-1707
        • Ryan A.S.
        • Buscemi A.
        • Forrester L.
        • Hafer-Macko C.E.
        • Ivey F.M.
        Atrophy and intramuscular fat in specific muscles of the thigh: associated weakness and hyperinsulinemia in stroke survivors.
        Neurorehabil Neural Repair. 2011; 25: 865-872
        • Ryan A.S.
        • Dobrovolny C.L.
        • Silver K.H.
        • Smith G.V.
        • Macko R.F.
        Cardiovascular fitness after stroke: role of muscle mass and gait deficit severity.
        J Stroke Cerebrovasc Dis. 2000; 9: 185-191
        • Evans W.J.
        • Campbell W.W.
        Sarcopenia and age-related changes in body composition and functional capacity.
        J Nutr. 1993; 123: 465-468
        • Baumgartner R.N.
        • Koehler K.M.
        • Gallagher D.
        • et al.
        Epidemiology of sarcopenia among the elderly in New Mexico.
        Am J Epidemiol. 1998; 147: 755-763
        • Cruz-Jentoft A.J.
        • Baeyens J.P.
        • Bauer J.M.
        • et al.
        Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People.
        Age Ageing. 2010; 39: 412-423
        • Fielding R.A.
        • Vellas B.
        • Evans W.J.
        • et al.
        Sarcopenia: an undiagnosed condition in older adults. Current consensus definition: prevalence, etiology, and consequences. International Working Group on Sarcopenia.
        J Am Med Dir Assoc. 2011; 12: 249-256
        • Morley J.E.
        • Abbatecola A.M.
        • Argiles J.M.
        • et al.
        Sarcopenia with limited mobility: an international consensus.
        J Am Med Dir Assoc. 2011; 12: 403-409
        • Cawthon P.M.
        • Peters K.W.
        • Shardell M.D.
        • et al.
        Cutpoints for low appendicular lean mass that identify older adults with clinically significant weakness.
        J Gerontol A Biol Sci Med Sci. 2014; 69: 567-575
        • Cruz-Jentoft A.J.
        • Landi F.
        • Schneider S.M.
        • et al.
        Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS).
        Age Ageing. 2014; 43: 748-759
        • Cruz-Jentoft A.J.
        • Landi F.
        • Topinkova E.
        • Michel J.P.
        Understanding sarcopenia as a geriatric syndrome.
        Curr Opin Clin Nutr Metab Care. 2010; 13: 1-7
        • Delmonico M.J.
        • Harris T.B.
        • Lee J.S.
        • et al.
        Alternative definitions of sarcopenia, lower extremity performance, and functional impairment with aging in older men and women.
        J Am Geriatr Soc. 2007; 55: 769-774
        • Bianchi L.
        • Ferrucci L.
        • Cherubini A.
        • et al.
        The predictive value of the EWGSOP definition of sarcopenia: results from the InCHIANTI study.
        J Gerontol A Biol Sci Med Sci. 2016; 71: 259-264
        • Folstein M.F.
        • Folstein S.E.
        • McHugh P.R.
        “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician.
        J Psychiatr Res. 1975; 12: 189-198
        • Radloff L.S.
        • Rae D.S.
        Susceptibility and precipitating factors in depression: sex differences and similarities.
        J Abnorm Psychol. 1979; 88: 174-181
        • Macko R.F.
        • DeSouza C.A.
        • Tretter L.D.
        • et al.
        Treadmill aerobic exercise training reduces the energy expenditure and cardiovascular demands of hemiparetic gait in chronic stroke patients. A preliminary report.
        Stroke. 1997; 28: 326-330
        • Landi F.
        • Liperoti R.
        • Fusco D.
        • et al.
        Prevalence and risk factors of sarcopenia among nursing home older residents.
        J Gerontol A Biol Sci Med Sci. 2012; 67: 48-55
        • Janssen I.
        • Shepard D.S.
        • Katzmarzyk P.T.
        • Roubenoff R.
        The healthcare costs of sarcopenia in the United States.
        J Am Geriatr Soc. 2004; 52: 80-85
        • Bijlsma A.Y.
        • Meskers C.G.
        • Ling C.H.
        • et al.
        Defining sarcopenia: the impact of different diagnostic criteria on the prevalence of sarcopenia in a large middle aged cohort.
        Age (Dordr). 2013; 35: 871-881
        • Patel H.P.
        • Syddall H.E.
        • Jameson K.
        • et al.
        Prevalence of sarcopenia in community-dwelling older people in the UK using the European Working Group on Sarcopenia in Older People (EWGSOP) definition: findings from the Hertfordshire Cohort Study (HCS).
        Age Ageing. 2013; 42: 378-384
        • Beaudart C.
        • Reginster J.Y.
        • Slomian J.
        • Buckinx F.
        • Locquet M.
        • Bruyere O.
        Prevalence of sarcopenia: the impact of different diagnostic cut-off limits.
        J Musculoskelet Neuronal Interact. 2014; 14: 425-431
        • Legrand D.
        • Vaes B.
        • Mathei C.
        • Swine C.
        • Degryse J.M.
        The prevalence of sarcopenia in very old individuals according to the European consensus definition: insights from the BELFRAIL study.
        Age Ageing. 2013; 42: 727-734
        • Volpato S.
        • Bianchi L.
        • Cherubini A.
        • et al.
        Prevalence and clinical correlates of sarcopenia in community-dwelling older people: application of the EWGSOP definition and diagnostic algorithm.
        J Gerontol A Biol Sci Med Sci. 2014; 69: 438-446
        • Ryan A.S.
        • Ivey F.M.
        • Prior S.
        • Li G.
        • Hafer-Macko C.
        Skeletal muscle hypertrophy and muscle myostatin reduction after resistive training in stroke survivors.
        Stroke. 2011; 42: 416-420
        • Patterson S.L.
        • Forrester L.W.
        • Rodgers M.M.
        • et al.
        Determinants of walking function after stroke: differences by deficit severity.
        Arch Phys Med Rehabil. 2007; 88: 115-119
        • Addison O.
        • Drummond M.J.
        • LaStayo P.C.
        • et al.
        Intramuscular fat and inflammation differ in older adults: the impact of frailty and inactivity.
        J Nutr Health Aging. 2014; 18: 532-538
        • Hafer-Macko C.E.
        • Yu S.
        • Ryan A.S.
        • Ivey F.M.
        • Macko R.F.
        Elevated tumor necrosis factor-alpha in skeletal muscle after stroke.
        Stroke. 2005; 36: 2021-2023
        • Mozaffarian D.
        • Benjamin E.J.
        • Go A.S.
        • et al.
        Heart disease and stroke statistics—2015 update: a report from the American Heart Association.
        Circulation. 2015; 131: e29-e322
        • Gianoudis J.
        • Bailey C.A.
        • Daly R.M.
        Associations between sedentary behaviour and body composition, muscle function and sarcopenia in community-dwelling older adults.
        Osteoporos Int. 2015; 26: 571-579