Sarcopenia and Risk of Falls in Patients With Major Chronic Diseases

Study Overview
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Brief Summary
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The objective of this study is to investigate the effects of therapeutic exercise and nutrition intervention for sarcopenia and risk of falls in patients with major chronic diseases. The outcomes will be analyzed regarding muscle strength, quality, and volume, etc., balance and gait, bone density, body composition, fall and quality of life after the intervention.

Detailed Description
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The main common chronic diseases in the elderly such as stroke, osteoporosis, chronic kidney disease and cancer, have been regarded as the fall high-risk patients. These patients are considered to be at risk for sarcopenia due to decreased exercise, nutritional status, and other reasons. Sarcopenia can be diagnosed and intervened effectively to delay the vicious cycle of health. Past studies have pointed out that in addition to drug intervention, treatment for sarcopenia must be accompanied by appropriate exercise and nutritional intervention (such as protein supplements, vitamin D) in order to achieve the best prevention and treatment.

Official Title
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Sarcopenia and Risk of Falls in Patients With Major Chronic Diseases - Effects of Therapeutic Exercise and Nutrition Intervention

Conditions
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Stroke, Osteoporosis, Chronic Kidney Diseases, Cancer

Intervention / Treatment
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* Behavioral: elastic band strengthening exercise
* Dietary Supplement: diet counseling


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 55-85 years old 3-6 months after onset walk independently for at least 10m Exclusion Criteria: lower limb Brunnstrom stage >5 combine other neuropathy diseases significant deformity of lower limb include: Modified Ashworth scale(MAS) >3; contracture, fracture, chronic joint pain. joint arthroplasty unstable vital sign can not cooperate study
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: exercise group<br>elastic band strengthening exercise | Behavioral: elastic band strengthening exercise<br>* 2-3days per week(150min per week)<br>* Other names: thera-band strengthening exercise;|
| Experimental: exercise combine diet counseling group<br>elastic band strengthening exercise combined diet counseling. | Behavioral: elastic band strengthening exercise<br>* 2-3days per week(150min per week)<br>* Other names: thera-band strengthening exercise;Dietary Supplement: diet counseling<br>* each patients in this group will receive4-5times diet counseling<br>* Other names: nutrition counseling;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change of walking speed | distance: 6m, patients can walk with foor orthosis and assistive devices | baseline: before intervention; follow-up: 3 months after intervention | 
| Change of grip force | Use a grip force meter (kg) to test both hands for test 3 times | before intervention; follow-up: 3 months after intervention | 
| Change of postural sway displacement | Use computerized dynography to measure the postural sway displacement (mm) | before intervention; follow-up: 3 months after intervention | 
| Change of postural sway velocity | Use computerized dynography to measure the postural sway velocity (mm/s) | before intervention; follow-up: 3 months after intervention | 
| Change of postural sway area | Use computerized dynography to measure the postural sway area (mm^2) | before intervention; follow-up: 3 months after intervention | 
| Change of step time | Use computerized dynography to measure spatial gait parameter: step time (ms) | before intervention; follow-up: 3 months after intervention | 
| Change of stance time | Use computerized dynography to measure spatial gait parameter: stance time (ms) | before intervention; follow-up: 3 months after intervention | 
| Change of swing time | Use computerized dynography to measure spatial gait parameter: swing time (ms) | before intervention; follow-up: 3 months after intervention | 
| Change of single support time | Use computerized dynography to measure spatial gait parameter: single support time (ms) | before intervention; follow-up: 3 months after intervention | 
| Change of double support time | Use computerized dynography to measure spatial gait parameter: double support time (ms) | before intervention; follow-up: 3 months after intervention | 
| Change of step length | Use computerized dynography to measure spatial gait parameter: step distance (mm) | before intervention; follow-up: 3 months after intervention | 
| Change of stance length | Use computerized dynography to measure spatial gait parameter: stance distance (mm) | before intervention; follow-up: 3 months after intervention | 
| Change of muscle thickness | Use ultrasound to assess muscles morphological parameter: thickness (mm). Target muscles include quadriceps, hamstring, anterior tibialis, gastrocnemius. | before intervention; follow-up: 3 months after intervention | 
| Change of muscle fiber length | Use ultrasound to assess muscles morphological parameter: fiber length (mm). Target muscles include quadriceps, hamstring, anterior tibialis, gastrocnemius. | before intervention; follow-up: 3 months after intervention | 
| Change of muscle fiber orientation angle | Use ultrasound to assess muscles morphological parameter: fiber orientation angle (degrees). Target muscles include quadriceps, hamstring, anterior tibialis, gastrocnemius. | before intervention; follow-up: 3 months after intervention | 
| Change of muscle cross section area | Use ultrasound to assess muscles morphological parameter: cross-sectional area (mm^2). Target muscles include quadriceps, hamstring, anterior tibialis, gastrocnemius. | before intervention; follow-up: 3 months after intervention | 
| Change of physiological cost index (PCI) | Heart rate (HR: beats/min) and walking speed (m/s) have been previously shown to be linearly related to oxygen uptake at sub-maximal exercise levels. Combination of these two parameters yields a single value in beats per meter, the physiological cost index (PCI). This is calculated as Working HR - Resting HR (beats/min) / Walking speed (m/s) | before intervention; follow-up: 3 months after intervention | 
| Change of international Quality of Life Assessment Short Form -36 (SF-36) | including 8 health concepts: (1) physical functioning, (2) role limitations because of physical health problems; (3) bodily pain, (4) social functioning, (5) general mental health (psychological distress and psychological wellbeing), (6) role limitations because of emotional problems, (7) vitality (energy/fatigue), (8) general health perceptions. Scoring: answers to each question are scored which are then summed and transformed to a 0 - 100 scale. The lower the score the more disability. The higher the score the less disability i.e., a score of zero is equivalent to maximum disability and a score of 100 is equivalent to no disability. | before intervention; follow-up: 3 months after intervention | 
| Change of amplitude of Muscle activity | use electromyography to measure the muscles activity in microvolts (uv) included quadriceps, hamstrings, tibialis anterior, gastrocnemius during subject walking in self-selected speed in 6 meters. | before intervention; follow-up: 3 months after intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change of concentration of CRP (C-Reactive Protein) | The concentration of CRP in the blood test. CRP is used mainly as a marker of inflammation. | before intervention; follow-up: 3 months after intervention | 
| Change of concentration of ALB (Serum albumin) | The concentration of ALB in the blood test. Albumin is the most important contributor to the maintenance of plasma colloid oncotic pressure; deficiency results in edema. | before intervention; follow-up: 3 months after intervention | 
| Change of concentration of Glomerular Filtration Rate (GFR) | The concentration of GFR in the blood test. The glomerular filtration rate is the best test to measure the patient's level of kidney function and determine the stage of kidney disease. It can calculate it from the results of the blood creatinine test. | before intervention; follow-up: 3 months after intervention | 
| Change of concentration of Hemoglobin (Hb) | The concentration of Hb in the blood test. | Time Frame: before intervention; follow-up: 3 months after intervention | 
| Change of concentration of Glucose SPOT | The concentration of Glucose SPOT in the blood test. TheSpot glucose measurement in epidermal interstitial fluid appears to be a promising alternative to capillary blood glucose estimation | Time Frame: before intervention; follow-up: 3 months after intervention | 
| Change of concentration of Cholesterol | The concentration of Cholesterol in the blood test. | before intervention; follow-up: 3 months after intervention | 
| Change of concentration of Triglyceride | The concentration of Triglyceride in the blood test. | before intervention; follow-up: 3 months after intervention | 
| Change of concentration of Transferrin | The concentration of Transferrin in the blood test. | before intervention; follow-up: 3 months after intervention | 
| Change of Berg balance test (BBS) | including 14 items which are scored on a 5 points scale (0-4). The degree of success in achieving each task is given a score of zero (unable) to four (independent), and the final measure is the sum of all of the scores. The item scores are summed, minimum score =0, maximum score = 56 | before intervention; follow-up: 3 months after intervention | 
| Change of Fugl-Meyer Assessment (FMA) | Items are scored on a 3-point ordinal scale (0 = cannot perform; 1 = performs partially; 2 = performs fully) Maximum Score = 226 points The 5 domains assessed include, Motor function (UE maximum score = 66; LE maximum score = 34), Sensory function (maximum score = 24), Balance (maximum score = 14), Joint range of motion (maximum score = 44), Joint pain (maximum score = 44) | before intervention; follow-up: 3 months after intervention | 
| Change of Body Mass Index (BMI) | (body weight) kg/(height) m*(height)m | before intervention; follow-up: 3 months after intervention | 
| Change of Mini-mental state examination (MMSE) | It is an 11-question measure that tests five areas of cognitive function: orientation, registration, attention and calculation, recall, and language. The maximum score is 30. A score of 23 or lower is indicative of cognitive impairment. | before intervention; follow-up: 3 months after intervention | 
| Change of Modified Ashworth scale (MAS) | measures resistance during passive soft-tissue stretching, the score is ranged from 0-4 0: No increase in muscle tone Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion when the affected part(s) is moved in flexion or extension 1+: Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM More marked increase in muscle tone through most of the ROM, but affected part(s) easily moved Considerable increase in muscle tone, passive movement difficult Affected part(s) rigid in flexion or extension | before intervention; follow-up: 3 months after intervention | 
| Change of Muscle tone | measure the muscle tone (kg/m) under muscle resting. Target muscles are quadricep, hamstring, anterior tibialis, gastrocnemius. | before intervention; follow-up: 3 months after intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Sarcopenia, stroke, osteoporosis, chronic kidney disease, cancer, balance and gait, fall