United Kingdom

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.

ISTRC 2021 - International Sarcopenia Translational Research Conference

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

leucine

randomised controlled trial

sarcopenia

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. 

poster

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: 
A third of people aged 65+ years fall every year, leading to fragility fractures in 10 - 15%, most commonly upper limb fractures
which are frequently the first sign of osteoporosis.
1) NICE clinical guidelines recommend
identifying and managing the risk factors for falling to prevent subsequent hip
fractures. It is estimated that by identifying these patients systematically, 25%
hip fractures (approximately 20,000 a
year in the UK) can be prevented
2) Osteoporosis and sarcopenia often coexist (osteo-sarcopenia) and both are
associated with increased risk of falls
and fractures. Early identification and
treatment of sarcopenia among older people with fragility arm
fractures could prevent further fractures.
3) This study evaluated the feasibility of assessing sarcopenia
among people aged 65+ years, who attend fracture clinic with
an upper limb fracture.
Methods:
4) This was a feasibility study
5) Patients aged 65 + years, with a single arm fracture (wrist or
upper arm), and able to give informed consent were recruited
from 3 fracture clinics in one acute hospital. Patients with
pathological fractures, multiple or lower limb fractures, active
cancer diagnosis or care home residents were excluded.
6) Sarcopenia was assessed using gait speed, grip strength with
unfractured arm (hand dynamometer using appropriate cut off
adjusted for age and gender), skeletal
muscle mass index SMI
(Bioimpedance BIA), SARC-F questionnaire, the European Working Group
on Sarcopenia in Older People
(EWGSOP) I and II criteria.
7) The sensitivity and specificity of each
measure was calculated against the
EWGSOP II criteria as the standard
reference.
Results:
Participant characteristics
• 100 patients (mean age 75 years± 7.2; 80 female) were recruited. Wrist (55%) and
 humerus (25%) were the most common type of fractures.
• Patients had comorbidities (mean=5 ± 3.45 ) and polypharmacy (mean No medications
=5 ± 3.4) but good physical (Barthel ADL median score=100, IQR (97,100)) and cognitive function (AMT median score=10, IQR (9,10)).
Prevalence of sarcopenia
• Sarcopenia was identified among 4% (EWGSOP I), 5% (SMI), 13% (EWGSOP II),
16% (gait speed test), 18% (SARC-F) and 39% (grip strength) see Table 1.
• Sarcopenia was significantly more prevalent among men with all measures: grip
strength (60% M vs 34% F), gait speed and SARC-F (40% M vs 12% F), the EWGSOP
II criteria (36% M vs 9% F) and EWGSOP I criteria (29% M vs 0% F).
• SARC-F had the best sensitivity (100%) and specificity (96%) against the EWGSOP II
criteria.
Feasibility of sarcopenia assessment
• Time needed to complete the assessments was on average 1-2 minutes for gait
speed, grip strength and SARC-F; 5 minutes for SMI, and 8-9 minutes when EWGSOP I
and II criteria were applied.
• Data were complete for grip strength and SARC-F. Missing data was reported among
2% for gait speed, 8% for SMI, 8% for EWGSOP II and 10% for EWGSOP I.
• The EWGSOP I & II criteria required most resources including: Jamar hand dynamometer,
measuring tape, and bioimpedance (BIA) machine. While SARC-F required the least resources (paper).
Conclusion
Assessing sarcopenia among older people with wrist or arm fractures was feasible in a busy fracture clinic. The self-completed questionnaire SARC-F had high sensitivity and specificity and was a quick, simple and cheap tool that could be suitable for routine use.
Prevalence of sarcopenia was significantly higher among men than women but the sample size was small and further research is needed
to confirm these findings.

The feasibility of assessing sarcopenia among older people with arm fracture using different criteria

Background:
SarQoL is a disease-specific quality-of-life
tool for use by patients with sarcopenia. The
questionnaire consists of 55 items organised
into 22 questions across seven domains:
Physical and mental health, Locomotion,
Body composition, Functionality, Activities of
daily living, Leisure activities and Fears.
Comprehensive validation data for SarQoL in
a UK population with sarcopenia are lacking.
This study tests SarQol’s internal
consistency, reliability, responsiveness and
external validity in a UK sarcopenia cohort.
Methods:
The SarQoL questionnaire was administered
by the research nurse at baseline and at sixmonth follow-up (by telephone) to assess
quality of life. Baseline visits were conducted
face to face (in a research clinic or in the
participants own home). Due to limitations on
face-to-face research activity imposed in the
UK as part of the pandemic response to
COVID-19, all but 8 follow-up visits were
conducted by telephone.
Measures of physical performance and selfreported function were also collected. The
SARC-F score was collected by telephone at
pre-screening and at the six-month follow-up
encounter. At baseline, maximum hand grip
strength, 4-metre walk speed and the Short
Physical Performance Battery (SPPB) were
measured.
At follow-up, participants were asked two
questions to assess global change in a)
fitness, and b) quality of life on a 7-point Likert
scale (much worse to much better).
Statistical analysis
All statistical analyses were conducted using
SPSS v26.
• Internal consistency was calculated using
Cronbach’s alpha.
• Reliability was calculated by intraclass
correlation in participants with no change in
a) their reported global fitness or b) their
quality of life.
• Responsiveness (Cohen’s d) was calculated
for participants reporting slight improvement
or worsening in their global scores.
• External validity was assessed by
comparing baseline SarQoL scores with
measures of physical performance and
functional ability.
Conclusions:
SarQoL showed:
• Good overall internal consistency
• Moderate reliability
• Evidence of criterion validity in crosssectional comparison with related measures.
• Variable responsiveness to change
Our results support the use of SarQoL as an
outcome measure in clinical trials of sarcopenia,
but further experience is required of its use in
trials to better define responsiveness and the
minimum clinically important difference (MCID)

Validity of the SarQoL quality of life tool in a UK population of older people with impaired physical function: findings from SarcNet

Introduction:
• Sarcopenia and frailty are common conditions affecting many older people living in the UK.
• A growing body of evidence supports resistance exercise training as a safe and effective intervention to improve muscle
strength in older people.
• Consensus guidelines released in 2018 strongly recommended the prescription of resistance-based physical exercise for
individuals with sarcopenia.
• However, a recent survey of current practice in the UK found that resistance exercise training was offered in only 9% of
departments delivering exercise interventions for sarcopenia and frailty with considerable variability demonstrated in the
content of the exercise interventions being offered across different sites
A Benchmarking and Feedback approach
• Debate continues as to the optimal duration,
frequency and intensity of exercise interventions
for sarcopenia and frailty in addition to how best
exercises should be progressed and the best
means of assessing outcomes for patients.
• A large-scale randomised control trial could
potentially address these questions; however this
would be a very lengthy and potentially costly
process.
• Alternatively, a benchmarking and feedback
model has the potential to drive service
improvement over a short timeframe through
cycles of assessment, feedback, and
improvement.
• The Benchmarking Exercise Programmes for
Older People project (BEPOP) draws upon the
experience of exercise professionals and
harnesses the variability seen in current practice
by gathering details of the content and outcomes
of exercise interventions currently offered to older
people from across multiple sites.
Proposed outcomes and future actions
• Data will be analysed to derive descriptive data on
each variable. Multiple regression analysis will be
performed to determine the relationship of
different exercise programme characteristics with
the greatest improvement in patient outcomes.
• Following review by an expert panel comprising
members of the British Geriatrics Society
Sarcopenia and Frailty Research Special Interest
Group, this data will inform the development of a
series of consensus guidelines for good practice
which shall be disseminated nationally to support
service development.
• Individual participants will receive tailored
feedback from our expert panel and signposting to
ongoing education and training resources.
• Participants will also be offered the opportunity to
benchmark their practice against a dashboard of
national practice.
• By undertaking multiple iterations of
benchmarking and feedback, those delivering
exercise training for older people with sarcopenia
or frailty will be able to share learning and evolve
practice towards the optimal duration, modality,
intensity, and frequency of interventions.
• Future cycles of benchmarking and feedback can
be adapted following the results of earlier
iterations as new questions for service
development arise.
Summary
• Recent work has shown that there is considerable variation in exercise interventions being offered to older
people living with sarcopenia and frailty and most are not in keeping with current best evidence.
• A benchmarking and feedback approach is an innovative, time-efficient, and cost-effective method of
engaging exercise professionals and promoting the development of exercise services for older people in
the UK. 

Improving exercise interventions for older people living with sarcopenia and frailty through a new UK wide benchmarking and feedback project

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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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

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