[Dossier] Everything about sarcopenia

Sarcopenia, from Greek Sarx (“flesh”) and Penia (“poverty”) is a condition directly linked to aging. It is defined by a progressive and generalized decrease in muscle mass, strength and physical performance. If this process insidiously starts in the thirties, it becomes particularly marked after 50. From this age, muscle loss accelerates and can reach 1% per year, leading to 70 years to a cast iron of almost half of the initial muscle capital. In France, sarcopenia affects 15% of people over 45 and 50% for those over 80.

Symptoms of sarcopenia

Sarcopenia does not settle down suddenly. She progresses slowly and sneakywithout spectacular symptoms at the start. The first signs are often trivialized by the elderly who, at the start, see it only as a normal consequence of their aging:

• Difficulties to get up with a chair
• Unusual breathlessness when the stairs climb
• Slowed walking speed
• Exacerbated muscle fatigue
• Difficulties in carrying heavy loads
• Loss of balance
• Increase in falls …

Gradually, These limitations become embarrassing, then disablingwith a direct impact on autonomy and quality of life.

Evolution and detection of the disease

The European working group on sarcopenia in the elderly (Ewgsop) has defined Three stages of the evolution of the disease :

• 1er stade : pre -Sarcopeniawhich is characterized by a decrease in muscle mass without significant alteration of strength or performance.
• 2e stade : mass loss associated with loss of strength or performancewith an increased risk of long -term functional consequences.
• 3E Stade: Severe sarcopenia which combines a decrease in the three parameters (mass, strength and performance), marking a major worsening of the risk of dependence, chutefractures and mortality.

Sarcopenia screening

To detect the disease, doctors rely on divers tests In order to assess muscle functions and physical performance.

1. The SARC-F questionnaire

The first tool used in practice is often the SARC-F questionnaire. He understands five questions Evaluator:

• the muscular strength (Strength),
• the walking capacity with or without help (Assistance),
• the Ability to get up from a chair (Rising),
• has go up stairs (Climbing)
• l’Fall History (Falls).

Each criterion is noted from 0 (no difficulty) to 2 (significant difficulty or impossibility). And total score greater than or equal to 4 indicates a suspicion of sarcopenia and justifies additional examinations. Studies show that this questionnaire has a good specificity (85%) and a high negative predictive value (96%), which makes it possible to reliably dismiss the disease when it is negative.

However, its sensitivity remains moderate (75%) and its lower positive predictive value (42%), which requires diagnostic confirmation by other tests.

2. Force evaluation tests

The doctor can then Measure muscle strength Using:

• And grip test : we squeeze a device in the hand to assess the force
• And Chair raising test : It consists in getting up and sitting five times without using your arms, in a limited time.

3. Physical performance measurement tests

Ces tests Allow the ability to make simple gestures:

• Walk 4 meters and measure the time put
• Test Timed up and Go (Tug): consists in getting up with a chair, walking 3 meters, coming back and dating
• Make a Small series of exercises combining balance, walking and strength

4. more specialized exams

In some cases, the doctor may offer further examinationsas :

• A Analysis of body composition To measure muscle mass
• And scannera IRM or a DEXA (examination also used for bone density)
• A bio-independence which analyzes the proportion of muscle and fat in the body

Thanks to these methods, it is therefore possible to quickly locate sarcopenia and to set up solutions, such as physical activity or food adjustments, to Preserve strength and autonomy.

Sarcopenic risk mechanisms and risk factors

Muscle cast iron Age linked results from a set of complex mechanisms. It first comes from a imbalance between synthesis and degradation of muscle proteinswhich is strengthened over time. But other factors come into play:

• A Gradual alteration of the nerve control muscle contraction
• A drop in hormones Anabolisantetes like testosterone or growth hormone
• The sexwomen being more at risk with menopause
• Of the insufficient nutritional intakeespecially in proteinand Vitamins deficiencies D, magnesium or omega 3
• Of the Chronic pathologies muscular loss
• A neurodegeneration age -related
• And lack of physical activity

The sedentary lifestyle plays a major role in this process. More than age itself, it is the lack of muscle solicitation that accelerates atrophy. With age advancement, periods of inactivity become more and more frequent: hospitalizations, fixed assets, convalescences … Even short periods of lining can have lasting deleterious effectssometimes difficult to catch up.

So, Sarcopenia feeds on inactivitycreating a vicious circle Between muscle loss, drop in mobility and worsening of fragility.

Consequences on health and autonomy

Sarcopenia is not just a “simple” muscular weakness: it has Multiple health repercussions and everyday life:

• Falls and fractures : The risk multiplied by 2 if the person suffers from sarcopenia, especially for fractures of the wrist and the femur pass.
• Loss of autonomy : Sarcopenia is one of the main dependence factors in the elderly (up to 40% of EHPAD residents are suffering from it).
• Medical complications : slower recovery after surgery or hospitalization, increased mortality in cancer patients (a loss of 5% of muscle mass increases the risk of mortality by 30%) or heart failure (doubles the risk of mortality).
• Psychological impact : Isolation, depressive riskloss of confidence.

Prevent and treat sarcopenia

If sarcopenia is a physiological phenomenon linked to age, However, it is inevitable. Simple strategies allow prevent it and treat it.

1. Physical activity

Physical activity constitutes the cornerstone of the fight against muscle melting. According to Professor Patrick Dehail of the Bordeaux CHU, these are Exercises against resistancelike light bodybuilding, the use of elastic bands or certain movements of body weight strengthening that bring the best results. Unlike endurance exercises alone (walking, swimming, cycling), insufficient to slow down the muscle decline, Resistance exercises directly stimulate the fibers and promote their maintenance.

It is never too late to get started : Even after 70 years, the benefits are visible from a few weeks of regular training. On average, After 12 to 18 weeksstrength and muscle power improve 25 to 30%. The gestures of daily life can also serve as an exercise (mounting stairs, getting up several times with a chair …)

For the most fragile peopleit is essential to be accompanied by a physiotherapist Or a professional trained in adapted activity in order to comply with efforts to individual capacities.

2. A powerful protein diet

The diet plays an equally crucial role. Indeed, protein needs increase with age. While young adults need approximately 0.8 g of protein per kilo and per day, The elderly must aim between 1 and 1.2 g/kg/day in prevention, and until 1.5 g in case of fragility or from disease.

Proteins must be Distributed over the day and ideally concentrated on the lunchwhen muscle synthesis is the most effective. Lean meats, fish, eggs, dairy products, legumes and vegetable proteins must be integrated daily.

3. Targeted supplementation

In addition, Some nutrients as Vitamin D (bone and muscle health), Omega-3 (anti-inflammatory effect), Creatine (strength and recovery improvement), or Some amino acids such as leucine or citrulline can Strengthen the protective effect food, always under medical advice. The current research also explores the place of vegetable proteins, chrononutrition or the influence of new hormones in muscle regulation.

A public health priority in an aging society

Francelike most developed countries, knows a rapid aging of its population. In 2030, one in three French people will be over 60 years old. The question is therefore no longer only to live for a long time, but from VHealthy ieirwith a preserved autonomy. Sarcopenia perfectly illustrates this challenge.

Prevention must start early, from 50 years oldor even before, by maintaining a Regular physical activity and a balanced diet. Preventing sarcopenia is preserving strength, autonomy and the quality of life of the seniors.

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