Low Magnitude Mechanical Stimulation to Increase Muscle Strength in Frail Adults

描述(申请人提供)：骨骼肌减少，与年龄相关的骨骼肌块的减少，导致行动能力受损，虚弱和残疾。然而，肌肉质量的丧失和肌肉力量的丧失之间存在不匹配，这表明肌肉质量随着年龄的增长而受损。脂肪渗入骨骼肌(肌骨瘤病)会影响肌肉质量 可能与行动不便和残疾有关。肌肉数量和肌肉质量可能是脆弱发展的早期可修改因素。这项提议的目标是 在1,172名65岁及以上社区男性的前瞻性队列中，研究外周定量计算机断层扫描评估的脂肪向骨骼肌渗透是否独立和交互地预测肌肉力量、体能、虚弱、残疾和死亡的下降。此外，我们假设改善肌肉质量和质量的干预措施将防止虚弱和残疾。因此，我们的第二个目标是研究一种对全身提供低强度机械刺激的低冲击、非药物设备是否能改善功能低下的成年人的肌肉力量。这项建议还将探讨低强度机械是否会增加肌肉质量和减少肌肉间脂肪。受试者将从当地辅助生活社区招募，这些社区为许多老年人提供聚集的住房和社交活动。我们假设，低强度的机械刺激将有助于对抗身体虚弱的老年人的骨质疏松症和独立性丧失，他们是不良后果的最高风险人群。这位以患者为导向的导师职业发展奖候选人旨在通过肌肉生理学、身体成分成像方法学和介入性临床研究方面的额外专业知识来补充她之前在老年病学和流行病学方面的培训。哥伦比亚大学已承诺投入大量资源支持这一提议，包括使用NIH CTSA资助的欧文研究所的生物营养、生物标记物实验室。由身体虚弱、身体成分、肌间脂肪和临床试验设计专家组成的多学科指导团队 在老年人中支持这项建议。拟议的研究将提供有关肌间脂肪在残疾发展中的重要性的新信息，并可能导致治疗和预防骨质疏松症的新策略。 公共卫生相关性：虚弱是一种老年综合征，它识别出易受伤害的成年人具有更高的不良后果风险。多系统失调的核心是骨骼减少和与年龄相关的肌肉力量丧失。骨质疏松症的经济影响及其有害后果是巨大的。迫切需要药物治疗和非药物治疗选择。阻力训练改善了多重结果，然而，许多老年人无法参加高强度运动计划。低幅度机械刺激是一种令人兴奋的、新颖的低影响干预措施，可以对抗老年人肌肉力量的丧失。这在预防残疾方面可能会对公共卫生产生很大影响。

DESCRIPTION (provided by applicant): Sarcopenia, the age-related loss of skeletal muscle mass, contributes to impaired mobility, frailty and disability. However, there is a mismatch between the loss in muscle mass and loss in muscle strength, suggesting that muscle quality is impaired with aging. Infiltration of fat into skeletal muscle (myosteatosis) affects muscle quality and may be related to impaired mobility and disability. Muscle quantity and muscle quality are potentially early modifiable factors in the development of frailty. The goal of this proposal is to examine whether infiltration of fat into skeletal muscle, assessed by peripheral quantitative computed tomography, independently and interactively predicts decline in muscle strength, physical performance, frailty, disability and death in a prospective cohort of 1,172 community dwelling men aged 65 years and older. Furthermore, we hypothesize that interventions that improve both muscle mass and quality will prevent weakness and disability. Thus, our second aim is to study whether a low-impact, nonpharmacologic device providing low magnitude mechanical stimulation to the whole body improves muscle strength in low functioning adults. This proposal will also explore whether low magnitude mechanical increases muscle mass and decrease intermuscular fat. Subjects will be recruited from local assisted living communities, which provide congregate housing and social events for many older adults. We hypothesize that low magnitude mechanical stimulation will help combat sarcopenia and loss of independence among frail older adults who are at the highest risk of adverse outcomes. The candidate for this mentored Patient-Oriented Career Development Award aims to complement her previous training in geriatrics and epidemiology with additional expertise in muscle physiology, body composition imaging methodology, and interventional clinical research. Columbia University has committed abundant resource to support this proposal including the use of bionutrition, biomarkers laboratory in the NIH CTSA-funded Irving Institute. A multidisciplinary mentorship team comprised of experts in frailty, body composition, intermuscular fat and clinical trial design in the elderly supports the proposal. The proposed studies should provide novel information about the importance of intermuscular fat in the development of disability, and could lead to new strategies for the treatment and prevention of sarcopenia. PUBLIC HEALTH RELEVANCE: Frailty is a geriatric syndrome that identifies vulnerable adults at increased risk for adverse outcomes. Central to the multisystem dysregulation is sarcopenia and age-related loss in muscle strength. The economic impact of sarcopenia and its detrimental consequences are immense. Pharmacologic and nonpharmacologic treatment options are badly needed. Resistance training improves multiple outcomes, however, many older adults are unable to participate in high-intensity exercise programs. Low magnitude mechanical stimulation is an exciting and novel low impact intervention to combat the loss of muscle strength in older adults. This may have a large public health impact in preventing disability.