Elsevier

Free Radical Biology and Medicine

Volume 132, 20 February 2019, Pages 42-49
Free Radical Biology and Medicine

Review Article
Sarcopenia, frailty and their prevention by exercise

https://doi.org/10.1016/j.freeradbiomed.2018.08.035Get rights and content

Highlights

  • Sarcopenia and frailty share common etiology.

  • Aging is associated with and altered redox signaling in skeletal muscle.

  • Modifiable risk factors improve protein synthesis and prevent muscle loss in aging.

  • Multidomain strategies are effective in the management of frailty and sarcopenia.

Abstract

Sarcopenia is a major component of the frailty syndrome, both being considered as strong predictors of morbidity, disability, and death in older people.

In this review, we explore the definitions of sarcopenia and frailty and summarize the current knowledge on their relationship with oxidative stress and the possible therapeutic interventions to prevent or treat them, including exercise-based interventions and multimodal strategies. We highlight the relevance of the impairment of the nervous system and of the anabolic response (protein synthesis) in muscle aging leading to frailty and sarcopenia. We also discuss the importance of malnutrition and physical inactivity in these geriatric syndromes. Finally, we propose multimodal interventions, including exercise programs and nutritional supplementation, as the strategies to prevent and treat both sarcopenia and frailty.

Section snippets

Sarcopenia and frailty: two interrelated concepts

As people age, some physiological changes frequently occur, such as decreased hormone production, increased oxidative stress, difficulty to provide adequate demand of oxygen to cells, and impairments in physical function. These changes are directly related to the risk of sarcopenia and frailty in the old population [1].

Primary sarcopenia is an age-related syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength with a risk of adverse outcomes such as

Nervous system

The nervous system function becomes impaired with aging. The basal ganglia, the cerebellum, and prefrontal cortex play a predominant role in motor planning and execution. Basal ganglia and cerebellum are mainly involved in motor planning while prefrontal cortex is related to the control and execution of movements [13]. The feedback loops between these structures mediate movement planning and control. Basal ganglia suffer a significant degenerative loss when compared to other brain areas during

Oxidative stress, sarcopenia, and frailty

Sarcopenia and frailty, even if they are different pathological entities, are closely related and have some mechanisms in common [61]. Oxidative stress is one of such mechanisms although its causative correlation is still under debate. This is the reason for describing some of the mechanisms involved in oxidative stress in both sarcopenia and frailty in this one single section (See Fig. 3). Sarcopenia is essentially caused by an alteration of the protein turnover leading to an imbalance between

Exercise interventions to improve sarcopenia and frailty

Accumulating evidence supports physical inactivity as a modifiable risk factor for developing many chronic diseases, such as diabetes, cancer, obesity, hypertension, musculoskeletal disorders and depression [91]. Indeed, regular physical exercise has become one of the key issues for the prevention of both chronic diseases and functional impairment, thus being considered of great importance for achieving a healthy lifestyle at all ages, especially in the old population [92], [93]. It is

Exercise alone is not enough

The complex etiology of sarcopenia and frailty explains the reason why isolated pharmacological and/or nutritional strategies do not seem to be effective enough in the prevention and treatment of these geriatric syndromes. Because the maintenance of muscle function is even more important than the maintenance of muscle mass, it is not surprising that interventions that have attempted to improve physical function in older persons by increasing muscle mass (IGF, growth hormone, testosterone) have

Acknowledgements

This work was supported by the following grants: Instituto de Salud Carlos III and co-funded by FEDER [grant number PIE15/00013], AICO/2016/076 from Conselleria de Educacion, Investigacion, Cultura y Deporte, SAF2016–75508-R from the Spanish Ministry of Education and Science (MEC), CB16/10/00435 (CIBERFES), PROMETEOII2014/056 de “Consellería, de Sanitat de la Generalitat Valenciana and EU Funded CM1001 and FRAILOMIC-HEALTH.2012.2.1.1-2 and ADVANTAGE-724099 Join Action (HP-JA) 3rd EU Health

Declarations of interest

None.

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