Prevalence risk of sarcopenia in older Brazilian adults during the pandemic: A cross-sectional analysis of the Remobilize Study

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ABSTRACT

BACKGROUND:

Social distancing has led to lifestyle changes among older adults during the coronavirus disease 2019 (COVID-19) pandemic.

OBJECTIVES:

This study aimed to estimate the prevalence risk of sarcopenia (RS) and investigate its associated factors during the COVID-19 pandemic in older Brazilian adults.

DESIGN AND SETTING:

Cross-sectional observational analysis of baseline data as part of the Remobilize Study.

METHODS:

Participants in the study were older adults (≥ 60 years), excluding those who were bedridden or institutionalized. The data collected consisted of answers about the RS (SARC-F), functional status, walking, sedentary behavior (SB), pain, comorbidity, and life space mobility.

RESULTS:

A total of 1,482 older adults (70 ± 8.14 years, 74% women) participated in the study, and an RS prevalence of 17.1% was found. (95% confidence interval [CI] 15.25–19.15%). The adjusted multivariate model showed a significant association between RS and functional limitation (odds ratio [OR]: 19.05; CI 13.00–28.32), comorbidity (OR: 5.11; CI 3.44–7.81), pain (OR: 4.56; CI 3.33–6.28), total walking (OR: 0.99; CI 0.99–1.00), SB of 8–10 hours (OR: 1.85; CI 1.15–2.93), and SB of > 10 hours (OR: 3.93; CI 2.48–6.22). RS was associated with mobility during the pandemic (OR: 0.97; CI 0.96–0.98). P < 0.05.

CONCLUSIONS:

During the pandemic, the prevalence of RS in older Brazilians was estimated at 17.1%. Moderate to severe functional limitation, comorbidities, presence of pain, walking, longer SB period, and reduced life space mobility significantly contributed to RS in older adults during the pandemic.

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Most cited references 57

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World Health Organization 2020 guidelines on physical activity and sedentary behaviour

Fiona Bull, Salih Al-Ansari, Stuart Biddle … (2020)

Objectives To describe new WHO 2020 guidelines on physical activity and sedentary behaviour. Methods The guidelines were developed in accordance with WHO protocols. An expert Guideline Development Group reviewed evidence to assess associations between physical activity and sedentary behaviour for an agreed set of health outcomes and population groups. The assessment used and systematically updated recent relevant systematic reviews; new primary reviews addressed additional health outcomes or subpopulations. Results The new guidelines address children, adolescents, adults, older adults and include new specific recommendations for pregnant and postpartum women and people living with chronic conditions or disability. All adults should undertake 150–300 min of moderate-intensity, or 75–150 min of vigorous-intensity physical activity, or some equivalent combination of moderate-intensity and vigorous-intensity aerobic physical activity, per week. Among children and adolescents, an average of 60 min/day of moderate-to-vigorous intensity aerobic physical activity across the week provides health benefits. The guidelines recommend regular muscle-strengthening activity for all age groups. Additionally, reducing sedentary behaviours is recommended across all age groups and abilities, although evidence was insufficient to quantify a sedentary behaviour threshold. Conclusion These 2020 WHO guidelines update previous WHO recommendations released in 2010. They reaffirm messages that some physical activity is better than none, that more physical activity is better for optimal health outcomes and provide a new recommendation on reducing sedentary behaviours. These guidelines highlight the importance of regularly undertaking both aerobic and muscle strengthening activities and for the first time, there are specific recommendations for specific populations including for pregnant and postpartum women and people living with chronic conditions or disability. These guidelines should be used to inform national health policies aligned with the WHO Global Action Plan on Physical Activity 2018–2030 and to strengthen surveillance systems that track progress towards national and global targets.

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Sarcopenia: European consensus on definition and diagnosis

Alfonso Cruz-Jentoft, Jean-Pierre Baeyens, Jürgen M Bauer … (2011)

The European Working Group on Sarcopenia in Older People (EWGSOP) developed a practical clinical definition and consensus diagnostic criteria for age-related sarcopenia. EWGSOP included representatives from four participant organisations, i.e. the European Geriatric Medicine Society, the European Society for Clinical Nutrition and Metabolism, the International Association of Gerontology and Geriatrics—European Region and the International Association of Nutrition and Aging. These organisations endorsed the findings in the final document. The group met and addressed the following questions, using the medical literature to build evidence-based answers: (i) What is sarcopenia? (ii) What parameters define sarcopenia? (iii) What variables reflect these parameters, and what measurement tools and cut-off points can be used? (iv) How does sarcopenia relate to cachexia, frailty and sarcopenic obesity? For the diagnosis of sarcopenia, EWGSOP recommends using the presence of both low muscle mass + low muscle function (strength or performance). EWGSOP variously applies these characteristics to further define conceptual stages as ‘presarcopenia’, ‘sarcopenia’ and ‘severe sarcopenia’. EWGSOP reviewed a wide range of tools that can be used to measure the specific variables of muscle mass, muscle strength and physical performance. Our paper summarises currently available data defining sarcopenia cut-off points by age and gender; suggests an algorithm for sarcopenia case finding in older individuals based on measurements of gait speed, grip strength and muscle mass; and presents a list of suggested primary and secondary outcome domains for research. Once an operational definition of sarcopenia is adopted and included in the mainstream of comprehensive geriatric assessment, the next steps are to define the natural course of sarcopenia and to develop and define effective treatment.

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Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment

Liang-Kung Chen, Jean Woo, Prasert Assantachai … (2020)

Clinical and research interest in sarcopenia has burgeoned internationally, Asia included. The Asian Working Group for Sarcopenia (AWGS) 2014 consensus defined sarcopenia as "age-related loss of muscle mass, plus low muscle strength, and/or low physical performance" and specified cutoffs for each diagnostic component; research in Asia consequently flourished, prompting this update. AWGS 2019 retains the previous definition of sarcopenia but revises the diagnostic algorithm, protocols, and some criteria: low muscle strength is defined as handgrip strength <28 kg for men and <18 kg for women; criteria for low physical performance are 6-m walk <1.0 m/s, Short Physical Performance Battery score ≤9, or 5-time chair stand test ≥12 seconds. AWGS 2019 retains the original cutoffs for height-adjusted muscle mass: dual-energy X-ray absorptiometry, <7.0 kg/m2 in men and <5.4 kg/m2 in women; and bioimpedance, <7.0 kg/m2 in men and <5.7 kg/m2 in women. In addition, the AWGS 2019 update proposes separate algorithms for community vs hospital settings, which both begin by screening either calf circumference (<34 cm in men, <33 cm in women), SARC-F (≥4), or SARC-CalF (≥11), to facilitate earlier identification of people at risk for sarcopenia. Although skeletal muscle strength and mass are both still considered fundamental to a definitive clinical diagnosis, AWGS 2019 also introduces "possible sarcopenia," defined by either low muscle strength or low physical performance only, specifically for use in primary health care or community-based health promotion, to enable earlier lifestyle interventions. Although defining sarcopenia by body mass index-adjusted muscle mass instead of height-adjusted muscle mass may predict adverse outcomes better, more evidence is needed before changing current recommendations. Lifestyle interventions, especially exercise and nutritional supplementation, prevail as mainstays of treatment. Further research is needed to investigate potential long-term benefits of lifestyle interventions, nutritional supplements, or pharmacotherapy for sarcopenia in Asians.

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Author and article information

Contributors

Patricia Parreira Batista:

ORCID: http://orcid.org/0000-0002-8036-882X

Role: conceptualization (equal)Role: data curation (equal)Role: formal analysis (equal)Role: investigation (equal)Role: methodology (equal)Role: writing-original draft (equal)

Monica Rodrigues Perracini:

ORCID: http://orcid.org/0000-0001-9331-3820

Role: conceptualization (equal)Role: data curation (equal)Role: formal analysis (equal)Role: investigation (equal)Role: methodology (equal)Role: project administration (equal)Role: writing-review and editing (equal)

Juleimar Soares Coelho de Amorim:

ORCID: http://orcid.org/0000-0003-3218-1769

Role: conceptualization (equal)Role: formal analysis (equal)Role: investigation (equal)Role: methodology (equal)Role: software (equal)Role: writing-review and editing (equal)

Maria do Carmo Correia de Lima:

ORCID: http://orcid.org/0000-0001-9018-5325

Role: formal analysis (equal)Role: investigation (equal)Role: methodology (equal)Role: visualization (equal)Role: writing-review and editing (equal)

Camila Astolphi Lima:

ORCID: http://orcid.org/0000-0001-9882-6975

Role: data curation (equal)Role: formal analysis (equal)Role: investigation (equal)Role: methodology (equal)Role: software (equal)Role: writing-review and editing (equal)

Daniele Sirineu Pereira:

ORCID: http://orcid.org/0000-0002-4868-9244

Role: conceptualization (equal)Role: formal analysis (equal)Role: investigation (equal)Role: methodology (equal)Role: supervision (equal)Role: writing-review and editing (equal)

Renata Gonçalves Dantas:

ORCID: http://orcid.org/0000-0002-1575-7204

Role: data curation (equal)Role: formal analysis (equal)Role: investigation (equal)Role: methodology (equal)Role: visualization (equal)

Etiene Oliveira da Silva Fittipaldi:

ORCID: http://orcid.org/0000-0002-1524-6930

Role: formal analysis (equal)Role: investigation (equal)Role: methodology (equal)Role: visualization (equal)

Aurélio Dias Santos:

ORCID: http://orcid.org/0000-0003-3693-9864

Role: formal analysis (equal)Role: investigation (equal)Role: methodology (equal)Role: visualization (equal)

Hércules Lázaro Morais Campos:

ORCID: http://orcid.org/0000-0002-6919-8161

Role: formal analysis (equal)Role: investigation (equal)Role: methodology (equal)Role: visualization (equal)

Leani Souza Máximo Pereira:

ORCID: http://orcid.org/0000-0001-7253-4392

Role: conceptualization (equal)Role: data curation (equal)Role: formal analysis (equal)Role: investigation (equal)Role: methodology (equal)Role: supervision (equal)Role: writing-review and editing (lead)

Journal

Journal ID (nlm-ta): Sao Paulo Med J

Journal ID (iso-abbrev): Sao Paulo Med J

Journal ID (publisher-id): spmj

Title: São Paulo Medical Journal

Publisher: Associação Paulista de Medicina - APM

ISSN (Print): 1516-3180

ISSN (Electronic): 1806-9460

Publication date (Electronic, pub): 19 December 2022

Publication date (Electronic, collection): 2023

Volume: 141

Issue: 4

Electronic Location Identifier: e2022159

Affiliations

[I ]PT, MSc. Doctoral Student Postgraduate Program in Rehabilitation Sciences, Department of Physiotherapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.

[II ]PT, PhD. Professor, Master’s and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo (SP), Brazil; Master’s and Doctoral Programs in Gerontology, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.

[III ]PT, PhD. Professor, Physical Therapy Course, Instituto Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brazil.

[IV ]PT, PhD. Faculty of Medical Sciences, Master’s and Doctoral Programs in Gerontology, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.

[V ]PT, PhD. Postdoctoral Student of Master’s and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo (SP), Brazil.

[VI ]PT, PhD. Professor, Postgraduate Program in Rehabilitation Sciences, Department of Physiotherapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.

[VII ]PT, MSc. Doctoral Student of Master’s and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo (SP), Brazil; and Professor of Physical Therapy, Universidade Estadual do Sudoeste da Bahia (UESB), Vitória da Conquista (BA), Brazil.

[VIII ]PT, PhD. Professor, Department of Physiotherapy, Universidade Federal de Pernambuco (UFPE), Recife (PE), Brazil.

[IX ]PT, MSc. Professor, Department of Physiotherapy, Centro Universitário Dr. Leão Sampaio (UNILEÃO), Juazeiro do Norte (CE), Brazil.

[X ]PT, MSc. Professor, Department of Physiotherapy, Universidade Federal do Amazonas/Instituto de Saúde e Biotecnologia (UFAM/ISB), Coari (AM), Brazil. Doctoral Student, Postgraduate Program in Public Health, Universidade Federal do Espírito Santo (UFES), Vitória (ES), Brazil.

[XI ]PT, PhD. Professor, Postgraduate Program in Rehabilitation Sciences, Department of Physiotherapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.

Author notes

Address for correspondence: Patricia Parreira Batista Universidade Federal de Minas Gerais (UFMG) Av. Pres. Antônio Carlos, 6.627 Pampulha — Belo horizonte (MG) — Brasil CEP 31270-901 Tel. (+55 31) 34097395 E-mail: ppb@ 123456ufmg.br

Authors’ contributions: All authors approved the final version of the study and reserved public responsibility for its content

Remobilize Research Network Affiliations: Alexandre da Silva, Francis Trombini-Souza, Adriana Guedes Carlos, Juliana Maria Gazzola, Mirian Moreira, Paulo Henrique Silva Pelicioni, Mônica Beatriz Ferreira, Etiene Duim, Nayara Tasse de Oliveira Cirino, Renata dos Ramos Varanda, Suzana Albuquerque de Moraes, Guilherme Medeiros de Alvarenga, Cristina Cristovão Ribeiro da Silva, Renato Barbosa dos Santos, Sarah Giulia Bandeira Felipe, and Lygia Paccini Lustosa (in memoriam)

Conflicts of interest: The authors declare no conflicts of interest