United Kingdom

Background: This study examined the impact of sarcopenia on clinical outcome in patients who underwent infrainguinal bypass surgery or major lower limb amputation (MLLA). Methods: Patients undergoing infra-inguinal bypass and MLLA in 2016-2018 were included in this retrospective analysis. Sarcopenia was identified by CT of muscle area at L3 vertebral. Primary outcome was overall survival, analysed using Cox regression. Secondary outcomes for bypass included ipsilateral MLLA, length of hospital stay, myocardial infarction and surgical-site infection. For the MLLA cohort we included stump infection and breakdown. These were analysed using Fisher’s test (categorical), Mann-Whitney U test (non-parametric) and t-test (parametric). Results: 216 patients (116 bypass, 100 MLLA) were included. 14/116 (12%) of bypass patients and 13/100 (13%) of MLLA patients were sarcopenic. Age, other co-morbidities, and laboratory tests were similar in those with and without sarcopenia. Overall survival was worse for sarcopenic patients (HR for death 5.8; 95%CI 1.8-19.1; p=0.001) in the bypass cohort, however, this was not observed in the MLLA cohort (HR 1.29; 95%CI 0.23-2.62; p=0.7). MLLA occurred more frequently in patients with sarcopenia (7/14 [50%] vs 23/102 [23%]; p=0.046). There was no difference in other secondary outcomes in either cohort. Conclusion: In the cohort of patients undergoing infrainguinal lower limb bypass, sarcopenia defined using L3 muscle area was significantly associated with overall mortality and MLLA, however sarcopenia was not associated with worse survival in the MLLA group. Sarcopenia and frailty may be a key factor in stratifying those who should undergo an amputation-first approach to CLTI.

ISTRC 2021 - International Sarcopenia Translational Research Conference

The influence of sarcopenia on lower limb bypass &amp; major lower limb amputation outcomes

revascularisation

amputation

surgery

vascular

Welcome to the inaugural International Sarcopenia Translational Research Conference.  “Where Worlds Meet” – the event brings together a broad range of researchers and practitioners in a truly interdisciplinary forum, covering discovery science through to clinical practice.

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Access to this event requires a registration. Please email Eleanor Lockhart at sarcconf@ncl.ac.uk if you have any questions regarding your registration. 

The influence of sarcopenia on lower limb bypass & major lower limb amputation outcomes

poster

Background: Mitochondrial dysfunction is a potential therapeutic target to improve skeletal muscle function, but the contribution of mitochondrial dysfunction to impaired skeletal muscle performance in older people remains unclear. The aim of this analysis was to test the association between measures of skeletal muscle mitochondrial function and physical performance in older people. Methods: We analysed data from the Allopurinol in Functional Impairment trial. Participants aged 65 and over, who were unable to walk 400 m in 6 min, underwent 31P magnetic resonance spectroscopy of the calf after exercise at baseline and at 20 weeks follow up. The phosphocreatine recovery half-life time (t1/2) was derived as a measure of mitochondrial function. Participants undertook the 6-min walk test and the Short Physical Performance Battery. Muscle mass measured using the Akern 101 bio-impedance analysis system. Bivariate correlations and multivariable regression analyses were conducted to determine associations between t1/2 and baseline factors. Results: One hundred and seventeen participants underwent baseline 31P magnetic resonance spectroscopy, mean age 80.4 years (SD 6.0); 56 (48%) were female. Mean 6-min walk was 291 m (SD 80), mean SPPB score was 8.4 (SD 1.9); t1/2 correlated significantly with Short Physical Performance Battery score (r = 0.22, P = 0.02) but not with 6-min walk distance (r = 0.10, P = 0.29). In multivariable linear regression, muscle mass and total body weight, but not t1/2, were independently associated with Short Physical Performance Battery score and with 6-min walk distance. Change in t1/2 was not significantly associated with change in Short Physical Performance Battery score (r = 0.03, P = 0.79) or with change in 6-min walk distance (r = −0.11, P = 0.28). Conclusions: Muscle mass, but not phosphocreatine recovery time, was consistently associated with Short Physical Performance Battery score and 6-min walk distance in older people with functional impairment.

Is Mitochondrial Function Measured by 31p Magnetic Resonance Spectroscopy Associated With Physical Performance in Older People With Functional Impairment?

Background: Sarcopenia, defined as the age-related loss of muscle mass and strength, is a major health problem. The condition is common, affecting between 5 and 10% of communitydwelling people aged over 65. It is a major cause of multiple adverse outcomes for older people including falls, fractures, hospital admission, prolonged length of stay, need for care and reduced survival. The objectives of the LACE trial were to determine the efficacy of leucine and perindopril in improving physical function, muscle mass and quality of life in older people diagnosed with sarcopenia. Methods: LACE was a placebo-controlled, parallel group, double-blind, randomised two-by-two factorial trial. Participants: Adults aged ≥70 years with low muscle strength and low muscle mass, without contraindications to ACE inhibitors and without known diagnosis-specific skeletal myopathy recruited from 14 UK centres. Interventions: Eligible participants were randomised 1:1 to 4mg oral perindopril or matching placebo, and separately randomised 1:1 to oral leucine powder 2.5g or matching placebo powder taken thrice daily with meals. Interventions were given for 12 months. Outcome measures: The primary outcome was the between-group difference in the Short Physical Performance Battery score (measured at baseline, 6 and 12 months). Secondary outcomes included grip strength, quadriceps strength, six-minute walk distance, appendicular muscle mass measured by dual x-ray absorptiometry and quality of life (EQ5D tool). All adverse events and falls were recorded. Outcomes were analysed using repeated measures mixed models, adjusted for baseline values, age, sex and minimisation variables. Prespecified subgroup analyses for the primary outcome were also conducted for age, sex and baseline protein intake. An initial test for treatment interaction showed no evidence of interaction and thus the perindopril vs placebo and leucine vs placebo comparisons were conducted separately. Recruitment: We screened 320 people and randomised 145 participants, mean age 79 (SD 6) years; 78 (54%) were women and the mean SPPB was 7.0 (SD 2.4). Figure 1 shows the CONSORT diagram for recruitment. Conclusion: Perindopril did not improve physical performance, muscle mass or quality of life in older people with sarcopenia in this trial.

Effect of perindopril on physical performance, muscle mass and quality of life in older people with sarcopenia: Results from the LACE randomised controlled trial

Background: Sarcopenia, defined as the age-related loss of muscle mass and strength, is a major health problem. The condition is common, affecting between 5 and 10% of communitydwelling people aged over 65. It is a major cause of multiple adverse outcomes for older people including falls, fractures, hospital admission, prolonged length of stay, need for care and reduced survival. The objectives of the LACE trial were to determine the efficacy of leucine and perindopril in improving physical function, muscle mass and quality of life in older people diagnosed with sarcopenia. Methods: LACE was a placebo-controlled, parallel group, double-blind, randomised two-by-two factorial trial. Participants: Adults aged ≥70 years with low muscle strength and low muscle mass, without contraindications to ACE inhibitors and without known diagnosis-specific skeletal myopathy recruited from 14 UK centres. Interventions: Eligible participants were randomised 1:1 to 4mg oral perindopril or matching placebo, and separately randomised 1:1 to oral leucine powder 2.5g or matching placebo powder taken thrice daily with meals. Interventions were given for 12 months. Outcome measures: The primary outcome was the between-group difference in the Short Physical Performance Battery score (measured at baseline, 6 and 12 months). Secondary outcomes included grip strength, quadriceps strength, six-minute walk distance, appendicular muscle mass measured by dual x-ray absorptiometry and quality of life (EQ5D tool). All adverse events and falls were recorded. Outcomes were analysed using repeated measures mixed models, adjusted for baseline values, age, sex and minimisation variables. Prespecified subgroup analyses for the primary outcome were also conducted for age, sex and baseline protein intake. An initial test for treatment interaction showed no evidence of interaction and thus the perindopril vs placebo and leucine vs placebo comparisons were conducted separately. Recruitment: We screened 320 people and randomised 145 participants, mean age 79 (SD 6) years; 78 (54%) were women and the mean SPPB was 7.0 (SD 2.4). Figure 1 shows the CONSORT diagram for recruitment. Conclusion: Leucine did not improve physical performance, muscle mass or quality of life in older people with sarcopenia in this trial.

Effect of leucine supplementation on physical performance, muscle mass and quality of life in older people with sarcopenia: Results from the LACE randomised controlled trial

Background: Anorexia of ageing is common but often not assessed in clinical practice despite the availability of simple tools such as the four-item Simplified Nutritional Appetite Questionnaire (SNAQ)1. Anorexia of ageing is associated with altered dietary pattern, weight loss and malnutrition, potentially contributing to the development of sarcopenia through loss of muscle mass. However, the association between appetite and muscle strength is less clear. Methods: Cross sectional observational study of community dwelling adults aged over 60 years, attending outpatient appointments in one hospital. Appetite was assessed using SNAQ; muscle strength by handgrip strength with a Jamar dynamometer and standard protocol. The association between appetite (SNAQ score between 5 and 20) and grip strength was assessed in unadjusted and adjusted continuous analyses. Results: We observed an association between poorer appetite and lower muscle strength in community dwelling older adults, independent of sex. This association was not robust when accounting for effects of age and comorbidity. Poor appetite may be associated with low muscle strength prior to older age and comorbidities but further investigation is needed. Appetite is simple to assess in older people using SNAQ and may prove useful in earlier identification of individuals at risk of developing sarcopenia.

Poor appetite is associated with lower muscle strength in community dwelling older adults

Introduction: • Physical activity in older adults has been shown to play a key role in the prevention of Sarcopenia1 . • There are barriers to physical activity in older adults, in particular environmental and access to resources2 . • The corona virus pandemic (COVID-19) caused the UK government to introduce measures to limit the spread of the virus such as: local & national lockdowns, self-isolation & shielding for vulnerable adults > 70 yrs. of age. • Few studies to date have quantitatively investigated the impact of the COVID-19 restrictions on physical activity in older adults. Methods: • Physical activity was measured in 14 volunteers (mean age ± SD: 62 ± 8) on two occasions; before restrictions (08/11/2018 - 02/03/2020) and during restrictions (10/11/2020 – 14/05/2021). • Participants wore a wrist-worn tri-axial accelerometer for 7 days. Minutes per day spent in moderate-vigorous physical activity (MVPA) and mean acceleration per hour (mg/h), were derived from recordings. • The average ratio of MVPA from the two assessments was used to assess changes in MVPA & differences in mean acceleration were analysed using a correlation analysis. Conclusions: • In this small population no significant changes in PA due to covid restrictions were observed. • More data from a wider age range should be collected to fully address the question of what impact covid restrictions have had on PA in older persons.

Assessing changes in physical activity in community dwelling older adults before and after COVID-19 restrictions in the United Kingdom

Background:
Resistance exercise can improve muscle strength and physical performance in older adults and is
recommended as a first-line treatment for sarcopenia. There is a growing interest surrounding the
exercise recovery process in older adults, and many studies are now seeking to characterise the
acute physiological side-effects of exercise1, and identify interventions to expedite recovery in
ageing populations.
However, we are unaware of any literature that has sought to define the perspectives of older
adults, or determine their knowledge of, exercise induced muscle damage and recovery.
To inform the direction of future research, it is important that researchers and practitioners alike
understand what exercise recovery means to older adults regarding barriers and motivators to
participation, willingness to train, and the acceptability of exercise recovery interventions.
Aims:
• To understand the knowledge and
attitudes to recovery from
resistance exercise in older adults at
risk of sarcopenia
• To explore how muscle soreness
may affect participation in
subsequent exercise bouts
Results:
1. 93 % of respondents said they would expect muscle soreness in
the days following intense exercise. However, this was often
associated with doing ‘too much’, and was viewed negatively.
2. A general misunderstanding of muscle damage and muscle
soreness was identified in our participants.
3. 152/291 (52 %) of respondents said that they would be discouraged
to at least some extent from completing their usual daily activities if
they were experiencing muscle soreness
4. 195/281 (67 %) of respondents said they would be discouraged
from completing further exercise until their muscle soreness had
subsided.
Conclusion:
• The ageing population may have poor knowledge of the exercise
recovery process. There is a need to educate older adults on the
expected short-term effects of resistance exercise.
• Reassurance that muscle damage and soreness are not due to
incorrect exercise practices, but a normal component of the training
process, may help to support ongoing engagement in resistance
exercise programmes.

Knowledge and Attitudes to Recovery from Resistance Exercise in Older Adults at Risk of Sarcopenia

Background: 
The Muscle Ageing and Sarcopenia Studies Lifecourse (MASS_Lifecourse)
project aims to establish a life course cohort a cohort of adults aged 45-85 to
investigate age-related changes in skeletal muscle.
Study participation consists of a home-based health and lifestyle assessment and
a clinic visit involving a range of physical measures and muscle biopsy.
In 2020, restrictions imposed in response to the coronavirus pandemic meant that
home-based assessments were impractical or a barrier to participation and
alternative data collection approaches were needed. As such, the
MASS_Lifecourse study began to explore the feasibility of completing health and
lifestyle assessments with participants virtually.
Method: 
Participants
After responding to a written invitation from their GP,
prospective participants (aged 45-85) were contacted to
confirm their eligibility for the study. Following this,
participants were asked if they were willing to
complete the home-based assessment virtually using Zoom
or Microsoft Teams.
A convenient time was arranged with participants who were emailed a link to the
virtual meeting in advance. Participants were briefed via telephone about how to
join the virtual meeting and advised to find a quiet, comfortable space. Prompts for
multiple choice questions were shown on the screen using Microsoft PowerPoint
via screen sharing.
Health and Lifestyle assessment
After providing informed consent, participants completed a detailed health and
lifestyle profile which included demographic and clinical history, medications, comorbidities, brief questionnaire assessments of sarcopenia, frailty, functional
impairment, quality of life, disability, lifestyle (physical activity, diet, smoking,
alcohol), social support and use of health care.
Assessment of feasibility and acceptability
Upon completion of the virtual assessment participants were asked “How did you
find this assessment?” and were prompted to provide any further thoughts and
feedback on using a video-conferencing system for research data collection.
Approval for the MASS_Lifecourse study was received from the North East - Tyne
& Wear South Research Ethics Committee.
Results:
Feasibility and acceptability
All participants (n = 6; age 53-75 years) who were asked to complete a virtual
assessment agreed (5 x Zoom; 1 x Microsoft Teams). Assessment duration
ranged from 39-62 minutes which was similar to previous home-based
assessments in the study.
Virtual assessments were acceptable to participants who were positive about their
experiences.
“Happy to do via Zoom” PID84
“Haven’t used Zoom before but has worked well” PID82
“Has worked fine via Zoom” PID81
Participant feedback
Participants found the video-conferencing system easy to use and indicated that
they felt comfortable engaging in the study from home.
“It was fine; it's been nice to do it from home; in front of
the fire, nice and comfortable” PID83
Some participants suggested that this approach was more convenient for them
compared with a traditional home visit.
“I like the convenience [of data collection via zoom], happy to have the link
emailed and felt that this worked well, felt comfortable being at home and doing
the data collection” PID87
Cognitive assessment
A sub-sample of participants (n = 2) also completed virtual assessments of global
cognition (MoCA and MMSE). This was a feasible and acceptable approach for
conducting this type of assessment in this group.
Conclusion:
Performing virtual assessments was feasible and acceptable to participants in the
MASS_Lifecourse study. These findings should encourage researchers to explore
the potential of virtual data collection.
However, this approach needs to be explored in a wider range of participants,
particularly in those less familiar with relevant technology to fully quantify the
potential of this approach.
It may be possible to achieve time savings (reduced travel to home visits) by
performing data collection virtually where feasible.

ZOOMing into the virtual world: remote data collection in the MASS_Lifecourse study

Introduction: 
1) Frailty – a risk factor of mortality and morbidity post-surgery
2) Currently available frailty scores – only assess one or selected few of
frailty’s components
3) Aims – to assess the feasibility of comprehensively measuring frailty of
elective cardiac surgery patients
Methods:
Study period – 01/12/2018 to 30/09/2020, follow-up until 31/12/2020
1) Patients – all cardiac surgery patients older than 70 years
2) Comprehensive frailty assessment in the pre-assessment clinic
3) NEFS – 1 point each, 11 in total, 4 points = frail
Results:
201 consecutively recruited – 36 excluded (incomplete assessment)
165 patients – 63 (38.2%) frail, 102 (61.8%) non-frail
Conclusion:
1) Feasible to comprehensively evaluate cardiac surgery patients’ frailty
using the North East frailty score
2) NEFS independently predicts post-cardiac surgery outcomes
3) Further validation is required
4) NEFS has the potential to facilitate the heart team to better risk
stratify patients and help patients make informed decision


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The influence of sarcopenia on lower limb bypass & major lower limb amputation outcomes

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