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Aging has made stroke a top killer and disabler, with post-stroke sarcopenia worsening disability and quality of life. While resistance training benefits the elderly, its impact on stroke patients is understudied. This study evaluates the potential of a 4-week unilateral resistance training (URT) program to prevent sarcopenia in stroke patients. It assesses the impact of URT on hand grip strength (HG), muscle thickness (MT), upper limb functionality, and the psychological status of the patients. The study aims to quantitatively analyze these indicators to inform evidence-based post-stroke rehabilitation practices. This study employed a randomized controlled trial (RCT) involving 77 eligible stroke survivors, equally allocated into a control group ( n  = 39) and an intervention group ( n  = 38). The control group received standard rehabilitation, while the intervention group additionally underwent a 4-week URT program. The primary outcomes were unaffected side HG and MT, measuring muscle mass and function. Secondary outcomes included the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) for upper limb functionality and the Hamilton Depression Rating Scale (HAMD) for psychological well-being changes. Statistical analysis showed significant differences ( p  < 0. 05) in all measured parameters between the intervention and control groups after the 4-week period. Intra-group comparisons also indicated substantial improvements ( p  < 0. 05). Unilateral resistance training significantly mitigates muscle atrophy in stroke patients, preventing sarcopenia and enhancing upper limb function. It also ameliorates depressive symptoms, improving rehabilitation outcomes and overall quality of life.

Background Sarcopenia is a progressive age‐related skeletal muscle disorder associated with increased likelihood of adverse outcomes. Muscle wasting is often accompanied by an increase in body fat, leading to ‘sarcopenic obesity’. The aim of the present study was to analyse the association of lifestyle variables such as diet, dietary components, physical activity (PA), body composition, and inflammatory markers, with the risk of sarcopenic obesity. Methods A cross‐sectional analysis based on baseline data from the PREDIMED‐Plus study was performed. A total of 1535 participants (48% women) with overweight/obesity (body mass index: 32.5 ± 3.3 kg/m2; age: 65.2 ± 4.9 years old) and metabolic syndrome were categorized according to sex‐specific tertiles (T) of the sarcopenic index (SI) as assessed by dual‐energy X‐ray absorptiometry scanning. Anthropometrical measurements, biochemical markers, dietary intake, and PA information were collected. Linear regression analyses were carried out to evaluate the association between variables. Results Subjects in the first SI tertile were older, less physically active, showed higher frequency of abdominal obesity and diabetes, and consumed higher saturated fat and less vitamin C than subjects from the other two tertiles (all P < 0.05). Multiple adjusted linear regression models evidenced significant positive associations across tertiles of SI with adherence to the Mediterranean dietary score (P‐trend < 0.05), PA (P‐trend < 0.0001), and the 30 s chair stand test (P‐trend < 0.0001), whereas significant negative associations were found with an inadequate vitamin C consumption (P‐trend < 0.05), visceral fat and leucocyte count (all P‐trend < 0.0001), and some white cell subtypes (neutrophils and monocytes), neutrophil‐to‐lymphocyte ratio, and platelet count (all P‐trend < 0.05). When models were additionally adjusted by potential mediators (inflammatory markers, diabetes, and waist circumference), no relevant changes were observed, only dietary variables lost significance. Conclusions Diet and PA are important regulatory mediators of systemic inflammation, which is directly involved in the sarcopenic process. A healthy dietary pattern combined with exercise is a promising strategy to limit age‐related sarcopenia.

Polypharmacy in older adults is associated with multiple negative consequences that may affect muscular function, independently from the presence of medical conditions. The aim of this systematic review and meta‐analysis was to investigate the association of sarcopenia with polypharmacy and higher number of medications. A systematic literature search of observational studies using PubMed, Web of Science, Scopus and Cochrane Library databases was conducted from inception until June 2022. To determine if sarcopenia is associated with a higher risk of polypharmacy and increased number of medications, a meta‐analysis using a random‐effects model was used to calculate the pooled effects (CRD42022337539). Twenty‐nine studies were included in the systematic review and meta‐analysis. Sarcopenia was associated with a higher prevalence of polypharmacy (odds ratio [OR]: 1.65, 95% confidence interval [CI] [1.23, 2.20], I2 = 84%, P < 0.01) and higher number of medications (mean difference: 1.39, 95% CI [0.59, 2.19], I2 = 95%, P < 0.01) compared with individuals without sarcopenia. Using meta‐regression, a high variance was observed due to different populations (i.e., community‐dwelling, nursing home residents, inpatients, outpatients) for both outcomes of polypharmacy (r = −0.338, SE = 0.1669, 95% CI [−0.67, −0.01], z = −2.03, P = 0.04) and number of medications (r = 0.589, SE = 0.2615, 95% CI [0.08, 1.10], z = 2.25, P = 0.02). This systematic review and meta‐analysis reported a significantly increased risk of polypharmacy and higher number of medications in people with sarcopenia compared with individuals without this condition. Future research should clarify whether the specificity and number of medications is a direct contributor in accelerating the progression of muscle wasting and dysfunction contributing to sarcopenia in older adults.

IntroductionPost-stroke patients with sarcopenia commonly exhibit impaired postural control and balance, which elevates fall risk and diminishes quality of life. This study investigates if combining Tai Chi with Dynamic Neuromuscular Stabilization (DNS) has synergistic benefits for neuromuscular control, core stability and balance in post-stroke patients with sarcopenia. Tai Chi enhances dynamic balance and lower limb strength through controlled weight-shifting movements. In contrast, DNS aims to restore neuromuscular synergy and regulate intra-abdominal pressure. It applies principles from developmental kinesiology. This study seeks to determine whether the combined intervention demonstrates significantly greater improvements in postural stability relative to isolated interventions or conventional rehabilitation approaches.Methods and analysisA single-blind randomised controlled trial will recruit 60 post-stroke patients with sarcopenia, randomly allocated into four groups: Tai Chi, DNS, Tai Chi+DNS and a control group (receiving conventional rehabilitation). Interventions will be conducted over 5 weeks, with primary outcomes evaluated using the Berg Balance Scale and Trunk Impairment Scale. Secondary outcomes comprise metrics from the Balance Manager System, 30-second Chair Stand Test, Timed Up and Go Test, bioelectrical impedance-derived phase angle, Modified Falls Efficacy Scale and Geriatric Depression Scale-Short Form.Ethics and disseminationThe Ethics Committee of the Second Rehabilitation Hospital of Shanghai has approved this study. The findings will be distributed by publication in indexed journals and presentation at global academic forums.Trial registration numberChiCTR2500102577.

Background Sarcopenia is highly prevalent among people being treated for various types of cancers and is associated with adverse clinical impacts including postoperative complications, chemotherapy-related toxicities, and poor survival. These impacts highlight the need for early intervention to mitigate the progression of sarcopenia during treatment. To date, substantial evidence from clinical trials supports the effectiveness of resistance exercise for reducing sarcopenia, yet the specific effects of prehabilitation exercise during neoadjuvant chemotherapy among patients with breast cancer remain underexplored. Methods This two-arm randomized controlled trial (RCT) aims to evaluate the effects of a supervised resistance exercise program in addressing sarcopenia, reducing treatment-related adverse effects, alleviating cancer-related symptoms, and improving quality of life (QOL) in patients with breast cancer undergoing neoadjuvant chemotherapy. Forty-six women (aged 20 years or older, diagnosed with breast cancer, and scheduled to start neoadjuvant chemotherapy) will be randomly assigned to either a resistance exercise group or a usual care control group. To overcome potential challenges related to geographic accessibility and treatment side effects, and to improve program completion, the exercise program offers a hybrid model with three expert-supervised exercise sessions per week available both on-site and online. Each supervised session lasts 60 min. Primary and secondary outcome measures include body composition (i.e., muscle mass), muscle strength, physical performance, treatment-related adverse effects, and self-reported cancer-related symptoms and QOL. Assessments will be conducted at baseline (pre-intervention), at 6 and 12 weeks during the intervention, and at completion of the intervention (18 weeks), using validated measures. The study was approved by the institutional review board of Yonsei University Health System’s Severance Hospital. Discussion This proposed pragmatic RCT will provide meaningful insights into the role of resistance exercise in mitigating sarcopenia and its impact on the clinical outcomes of neoadjuvant chemotherapy for breast cancer. The trial is also expected to contribute to the development of evidence-based sarcopenia interventions tailored to patients with breast cancer and to help guide future directions for clinical practice and research. Trial registration This trial was prospectively registered in the Clinical Research Information Service (reference number KCT0008961) in the Republic of Korea on November 16, 2023.

Background Endothelial damage induces myofibrillar breakdown and muscle degradation in COVID‐19 infection. There is a relationship between increased endothelin‐1 synthesis and sarcopenia. We evaluated the preventive effect of early bosentan therapy as an endothelin receptor blocker in sarcopenia in high‐risk outpatients with COVID‐19 infection. Methods From 15 December 2021 to 15 August 2023, patients within 3 days of the onset of signs and symptoms were randomly assigned to receive bosentan, 62.5 mg, or placebo, twice daily from enrollment for 30 days. The primary outcome was disease progression (death or hospitalization within 15 days after randomization), and the data for this outcome have been previously published. Sarcopenia as a secondary outcome was assessed prospectively at 3, 6, 9 and 12 months after randomization using the criteria of the Asian Working Group for Sarcopenia (AWGS) 2019 (IRCT.ir, IRCT20211203053263N1). Results A total of 313 patients (156 bosentan group, 157 controls) were included in the analyses, which were performed under the intent‐to‐treat principle. Overall, the incidence of sarcopenia was 8.6% (n = 27). Nineteen (73%) had severe sarcopenia. At the 3‐month follow‐up, the incidence of sarcopenia was 8.3% in the total population, with the significant risk difference (RD) of −10.17% in the bosentan group versus the control group. The incidence in the total population and RD in the bosentan group versus the control group at months 6, 9 and 12 were 8.6% (RD: −10.81%, p < 0.001), 8.3% (RD: −10.17%, p = 0.001) and 5.4% (RD: −6.99%, p = 0.003), respectively. During the study, 29 people developed severe COVID‐19 and were hospitalized. At follow‐up, sarcopenia occurred in four inpatients and 23 outpatients (p = 0.23). Mortality occurred in 5.1% (n = 16) of the total population, including 4 (1.3%) of the patients in the bosentan group and 12 (3.8%) of the patients in the placebo group (p = 0.069). None of the patients who died had sarcopenia. Bosentan did not cause any severe adverse events and was well tolerated. Conclusion Early administration of bosentan may prevent sarcopenia in high‐risk outpatients with COVID‐19.

The assessment of sarcopenia is part of the nutritional assessment index and is essential in stroke management. This study aimed to identify and validate cutoff values of temporal muscle thickness (TMT) measured using computed tomography to identify sarcopenia after acute stroke. The participants were patients with stroke aged ≥65 years who were admitted to rehabilitation units. The recruited patients were randomly divided into the calculation and validation cohort. In the calculation cohort, TMT cutoff values for identifying sarcopenia were calculated using receiver operating characteristic analysis. The obtained values were validated in the validation cohort using sensitivity and specificity. The calculation cohort included 230 patients (125 men, mean age, 77.2 ± 7.2 years), whereas the validation cohort included 235 patients (125 men, mean age, 76.4 ± 6.95 years). The TMT cutoff values for identifying sarcopenia and low skeletal muscle index were the same: 3.83 mm for men and 2.78 mm for women. The TMT cutoff value for identifying sarcopenia showed a sensitivity and specificity of 0.642 and 0.750, respectively, for men, and 0.660 and 0.567, respectively, for women. We identified a valid cutoff value of temporal muscle thickness for identifying sarcopenia after acute stroke. TMT is easy to measure and may be useful for the early detection of sarcopenia.

Introduction: Leptin and ghrelin are two hormones that play a role in weight homeostasis. Leptin, which is produced primarily by adipocytes and is dependent on body fat mass, suppresses appetite and increases energy expenditure. Conversely, ghrelin is the “hunger hormone”, it stimulates appetite and promotes fat storage. Bariatric surgery significantly alters the levels and activity of these hormones, contributing to weight loss and metabolic improvements. Clarifying the interplay between bariatric surgery, weight loss, physical exercise, leptin, and ghrelin is essential in developing comprehensive strategies for optimizing the long-term outcomes for candidates who have undergone bariatric surgery, especially for sarcopenic patients. Methods: This was a randomized controlled study with two groups (n = 22). The patients in both groups had obesity and sarcopenia. A Roux-en-Y-gastric bypass (RYGB) procedure was performed on all patients. The intervention group participated in a structured exercise program three times per week, beginning one month after surgery and lasting 16 weeks. Patient assessment was performed before surgery (baseline) and after the completion of the exercise program. The control group received the usual standard of care and was assessed similarly. Results: After surgery, weight, BMI, and lean mass decreased significantly in both groups between the baseline and the second assessment. Leptin levels were not significantly different between baseline and the second assessment in the physical exercise group, but were significantly lower in the control group (p = 0.05). Ghrelin levels increased over time in both groups, but the differences were not significant. When we associated leptin (the dependent variable) with weight (the independent variable), we found that lower weight was associated with lower leptin levels. A similar relationship was also observed between the leptin and sarcopenia parameters (muscle strength and mass), as well as in the bone health parameters (bone mineral density and t-score). Higher ghrelin levels were significantly associated with higher t-scores and z-scores (p < 0.05). Conclusion: Exercise has been shown to have a significant effect on leptin and ghrelin levels after bariatric surgery. By incorporating regular physical activity into their lifestyle, bariatric patients can optimize their weight loss outcomes and improve their overall health. After the physical exercise protocol, patients in the intervention group revealed more established leptin levels, which may indicate a protected pattern concerning decreased leptin levels. An unfavorable profile was evidenced, according to which greater weight loss, sarcopenia, and osteoporosis were associated with lower leptin levels.

Background: Low-carbohydrate (LC) diets are an effective method for treating obesity and reducing cardiometabolic risk. However, exposure to LC diets is associated with reductions in muscle mass and increased osteoporosis risk in obese individuals. The combination of exercise with a LC diet appears to attenuate muscle mass loss induced by LC diets alone, and to further improve cardiometabolic profile. However, evidence to date in obese individuals is limited. We assessed the effect of LC diet in combination with supervised exercise on cardiorespiratory fitness, body composition and cardiometabolic risk factors in obese individuals. Methods: Male and female participants in the experimental (EX-LC; structured supervised exercise program + low-carbohydrate meals; n = 33; 35.3 years) and control (EX-CO; structured supervised exercise program + standard dietary advice; n = 31; 34.2 years) conditions underwent measurements of cardiorespiratory fitness (VO2peak), body fat, lean muscle mass (LMM), and cardiometabolic biomarkers before and after an 8 week intervention. Results: Participants in the EX-LC condition demonstrated greater improvements in VO2peak (p = 0.002) and fat mass index (FMI, p = 0.001) compared to the EX-CO condition. Achieving a ketogenic state (β-hydroxybutyrate, βHB ≥0.3 mmol/L) was associated with greater reductions in total body fat (p = 0.011), visceral adipose tissue (p = 0.025), FMI (p = 0.002) and C-reactive protein (CRP, p = 0.041) but also with greater reductions in LMM (p = 0.042). Conclusion: Short-term LC diet combined with prescribed exercise enhanced cardiorespiratory fitness and the cardiometabolic profile of obese individuals but was also associated with greater muscle mass loss compared to similar exercise training and standard dietary advice. The long-term effects of the LC diet should be further explored in future studies.

Background Patients diagnosed with pancreatic, biliary tract, and liver cancer often suffer from a progressive loss of muscle mass. Given the considerable functional impairments in these patients, high musculoskeletal weight loads may not be well tolerated by all individuals. The use of blood-flow restricted resistance training (BFR-T) which only requires low training loads may allow for a faster recovery of muscle due to avoidance of high levels of mechanical muscle stress associated with high-load resistance exercise. This study aims to investigate whether BFR-T can prevent or slow down the loss of skeletal muscle mass and enhance the functional capacity and mental health of patients with pancreatic, biliary tract, and liver cancer. Methods The PREV-Ex exercise trial is a multicenter two-armed randomized controlled trial. Patients will be randomized to an exercise program consisting of home-based low-load BFR-T during a combined pre- and postoperative period for a total of 6–10 weeks (prehabilitation and rehabilitation), or to a control group. Protein supplementation will be given to both groups to ensure adequate protein intake. The primary outcomes, skeletal muscle thickness and muscle cross-sectional area, will be assessed by ultrasound. Secondary outcomes include the following: (i) muscle catabolism-related and inflammatory bio-markers (molecular characteristics will be assessed from a vastus lateralis biopsy and blood samples will be obtained from a sub-sample of patients); (ii) patient-reported outcome measures (self-reported fatigue, health-related quality of life, and nutritional status will be assessed through validated questionnaires); (iii) physical fitness/performance/activity (validated tests will be used to evaluate physical function, cardiorespiratory fitness and maximal isometric muscle strength. Physical activity and sedentary behavior (assessed using an activity monitor); (iv) clinical outcomes: hospitalization rates and blood status will be recorded from the patients’ medical records; (v) explorative outcomes of patients’ experience of the exercise program which will be evaluated using focus group/individual interviews. Discussion It is worthwhile to investigate new strategies that have the potential to counteract the deterioration of skeletal muscle mass, muscle function, strength, and physical function, all of which have debilitating consequences for patients with pancreatic, biliary tract, and liver cancer. The expected findings could improve prognosis, help patients stay independent for longer, and possibly reduce treatment-related costs. Trial registration ClinicalTrials.gov NCT05044065. Registered on September 14, 2021.