Detection of and lifestyle interventions for sarcopenia in older adults, and their application in cardiac rehabilitation

James, Emily J C (2024) Detection of and lifestyle interventions for sarcopenia in older adults, and their application in cardiac rehabilitation. Doctoral thesis, Northumbria University.

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Abstract

Co-existing sarcopenia and coronary heart disease (CHD) is common and worsens prognosis but has received little empirical focus. This Thesis culminates with the design and evaluation of a targeted sarcopenia intervention in people with CHD, informed by initial studies which (1) further our understanding of existing interventions for sarcopenia in a general population, and (2) establish underpinning drivers of skeletal muscle adaptation/maladaptation in people with CHD.

A six-year, retrospective service evaluation demonstrated that a community-run strength and balance exercise programme improved physical function in older adults. In a systematic review and meta-analysis of 27 randomised controlled trials, we report improved neuromuscular function in older adults after resistance exercise training. These chapters corroborate and extend existing research highlighting resistance exercise as an effective sarcopenia treatment.

Analysis of circulatory biomarkers showed that low muscle mass in people with CHD was associated with lower concentrations of inflammatory and nutrition-related markers. Nutrition appears to be awarded low priority in UK cardiac rehabilitation (CR) programmes, demonstrated in a survey of dietary education practices in UK-based CR. To address this, we conducted a pilot randomised controlled trial to assess whether targeted protein education can be embedded within standard CR. The intervention appeared well received by those who completed the study; however, changes to dietary intake following intervention were minimal, uptake to the study was low and attrition high.

This Thesis furthers our understanding of sarcopenia diagnosis and treatment in the general population and applies this knowledge to people with CHD. It demonstrates the effectiveness of established interventions to improve muscle strength and function, highlights circulatory factors associated with sarcopenia in CHD, contributes to audit and evaluation of CR dietetic services, and presents a novel dietary intervention. This work sets a platform for research and practice to tailor sarcopenia diagnosis and prevention to people with CHD.

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