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      Trimetazidine in angina and poor muscle function: protocol for a randomized controlled study

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          Abstract

          Background:

          Low handgrip strength (HS) and declining gait speed (GS) are increasingly obvious with aging, requiring effective, and safe medication for treatment. Trimetazidine (TMZ) modified release tablets, a common anti-angina drug, has potential benefits for alleviating the condition, but this has not yet been fully studied and therefore is the aim of this study.

          Methods:

          This is a prospective randomized controlled study. Fifty-eight eligible patients will be randomly assigned to one of two study groups: TMZ group or control group. For the TMZ group, a dose of 35 mg of oral TMZ will be administered with a meal twice a day for 3 months, in addition to any conventional treatments for angina. Only conventional treatments for angina will be administrated in the control group. The primary outcome will be the 6-min walking distance and the secondary outcomes will be: muscle strength (HS and pinch strength), GS, muscle endurance (five times sit-to-stand test), balance maintenance (tandem standing test), and the frequency of angina per week. Additionally, body mass index, circumferences (biceps, waist, hip, and calf), albumin levels, and the score on a five-question scale for sarcopenia will be obtained during the study.

          Discussion:

          This study aims to evaluate the usefulness of TMZ in a population with poor muscle function. The results may provide an effective and safe medical treatment to people with low muscle strength or physical performance.

          Trial registration:

          Chinese Clinical Trial Registry, ChiCTR1800015000; www.chictr.org.cn/showproj.aspx?proj=25445.

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          Most cited references18

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          Recent Advances in Sarcopenia Research in Asia: 2016 Update From the Asian Working Group for Sarcopenia

          Sarcopenia was recently classified a geriatric syndrome and is a major challenge to healthy aging. Affected patients tend to have worse clinical outcomes and higher mortality than those without sarcopenia. Although there is general agreement on the principal diagnostic characteristics, initial thresholds for muscle mass, strength, and physical performance were based on data from populations of predominantly Europid ancestry and may not apply worldwide. The Asian Working Group for Sarcopenia (AWGS) issued regional consensus guidelines in 2014, and many more research studies from Asia have since been published; this review summarizes recent progress. The prevalence of sarcopenia estimated by the AWGS criteria ranges between 4.1% and 11.5% of the general older population; however, prevalence rates were higher in Asian studies that used European Working Group on Sarcopenia in Older People cut-offs. Risk factors include age, sex, heart disease, hyperlipidemia, daily alcohol consumption, and low protein or vitamin intake; physical activity is protective. Adjusting skeletal muscle mass by weight rather than height is better in showing the effect of older age in sarcopenia and identifying sarcopenic obesity; however, some Asian studies found no significant skeletal muscle loss, and muscle strength might be a better indicator. Although AWGS 2014 diagnostic cut-offs were generally well accepted, some may require further revision in light of conflicting evidence from some studies. The importance of sarcopenia in diverse therapeutic areas is increasingly evident, with strong research interest in sarcopenic obesity and the setting of malignancy. Pharmacologic interventions have been unsatisfactory, and the core management strategies remain physical exercise and nutritional supplementation; however, further research is required to determine the most beneficial approaches.
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            Interventions for sarcopenia and muscle weakness in older people.

            three major strategies have been tested for combating the losses in muscle mass and strength that accompany ageing. Those strategies are testosterone replacement for men, growth hormone replacement and resistance exercise training. This review will cover the risks and benefits associated with each of these interventions. searches of PubMed and Web of Science through May 2004 yielded 85 relevant citations for the following descriptors: sarcopenia, aging/ageing, elderly, testosterone, hormone replacement, growth hormone, resistance training, exercise, muscle mass, nutrition and strength. testosterone replacement in elderly hypogonadal men produces only modest increases in muscle mass and strength, which are observed in some studies and not in others. Higher doses have not been given for fear of accelerating prostate cancer. Growth hormone replacement in elderly subjects produces a high incidence of side-effects, does not increase strength and does not augment strength gains resulting from resistance training. Some alternate strategies for stimulating the growth hormone/insulin-like growth factor (IGF) pathway continue to hold promise. The latter include growth hormone releasing hormone (GHRH) and the complex of IGF-I with its major circulating binding protein (IGF-I/IGFBP-3). Resistance training remains the most effective intervention for increasing muscle mass and strength in older people. Elderly people have reduced food intake and increased protein requirements. As a result, adequate nutrition is sometimes a barrier to obtaining full benefits from resistance training in this population.
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              Defining sarcopenia in terms of incident adverse outcomes.

              The objectives of this study were to compare the performance of different diagnoses of sarcopenia using European Working Group on Sarcopenia in Older People, International Working Group on Sarcopenia, and the US Foundation of National Institutes of Health (FNIH) criteria, and the screening tool SARC-F, against the Asian Working Group for Sarcopenia consensus panel definitions, in predicting physical limitation, slow walking speed, and repeated chair stand performance, days of hospital stay and mortality at follow up.
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                Author and article information

                Journal
                Chin Med J (Engl)
                Chin. Med. J
                CM9
                Chinese Medical Journal
                Wolters Kluwer Health
                0366-6999
                2542-5641
                20 June 2019
                20 June 2019
                : 132
                : 12
                : 1461-1466
                Affiliations
                [1 ]Department of Geriatric Cardiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
                [2 ]Department of Rehabilitation, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, Henan 450007, China
                [3 ]Department of Rehabilitation, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
                Author notes
                Correspondence to: Prof. Xiao-Ying Li, Department of Geriatric Cardiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China E-Mail: xyli3012@ 123456163.com
                Article
                CMJ-2018-460
                10.1097/CM9.0000000000000267
                6629326
                31205105
                84468222-101e-49a7-a195-e1f3a20084d4
                Copyright © 2019 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

                History
                : 21 December 2018
                Categories
                Study Protocol
                Custom metadata
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                trimetazidine,angina,strength,physical performance
                trimetazidine, angina, strength, physical performance

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