Influência da prática de atividade física e dos padrões sedentários sobre a sarcopenia, obesidade sarcopênica, obesidade osteosarcopênica e incapacidade funcional em idosos: coorte de 24 meses
Carregando...
Arquivos
Data
2018-02-26
Autores
Santos, Vanessa Ribeiro dos
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução. A sarcopenia e obesidade sarcopênica (OS) são fatores de risco da obesidade osteosarcopênica (OOS), que foi descrita como a coexistência de três condições desfavoráveis da composição corporal (sarcopenia, obesidade e osteopenia/osteoporose), que podem resultar em um quadro mais agravante para redução do desempenho físico, risco de quedas, fraturas, hospitalizações e incapacidade funcional. A ocorrência desses agravos da composição corporal, além do risco para incapacidade funcional podem estar associados a fatores comportamentais modificáveis como, a prática insuficiente de atividade física (AF) e o comportamento sedentário. Objetivo. Analisar, após 24 meses de seguimento, a associação da prática de AF e do comportamento sedentário com sarcopenia, OS, OOS e incapacidade funcional em idosos. Métodos. A amostra final do estudo foi composta por 211 idosos de ambos os sexos, com idade entre 60 e 93 anos (72±7 anos), 72% mulheres, residentes no município de Presidente Prudente, São Paulo. As variáveis investigadas foram: i) composição corporal pela técnica laboratorial de Absorciometria Radiológica de Dupla Energia (DEXA); ii) força de preensão manual mensurada por dinamômetro digital; iii) nível de atividade física e comportamento sedentário (questionário e acelerômetro); iv) desempenho físico (testes físicos); e v) variáveis controle [doenças crônicas não transmissíveis (DCNT), idade, sexo, etnia, renda e hábito de fumar (autorreferidos)]. Resultados. Verificou-se que idosos que, ao longo do período de seguimento, apresentaram baixa massa muscular (HR: 3,71; IC 95% 1,15-11,96), baixa velocidade de marcha (HR: 4,15; IC 95% 1,38-12,50), bem como excesso de gordura corporal (HR: 3,82; IC 95% 1,18-12,37), e que permaneceram insuficientemente ativos no domínio locomoção apresentaram maior risco de OS. O risco para incapacidade funcional foi maior em idosos com sarcopenia que permaneceram insuficientemente ativos nos domínios exercício físico no lazer (HR: 1,94; IC 95% 1,03-3,63), e locomoção (HR: 2,67; IC 95% 1,46-4,88), bem como para prática de AFH total (HR: 2,25; IC 95% 1,06-4,75). Para aqueles com OS que permaneceram insuficientemente ativos nos três domínios, os valores foram: ocupacional (HR: 2,40; IC 95% 1,15-5,00), exercício físico no lazer (HR: 1,94; IC 95% 1,03-3,65), locomoção (HR: 2,44; IC 95% 1,33-4,47), e para prática de AFH total (HR: 2,60; IC 95% 1,26-5,37). Em idosos com osteopenia/osteoporose foram encontradas as seguintes correlações: bouts >60 min associou-se negativamente com a densidade mineral óssea (DMO) da coluna (β=- 0,03; IC 95% -0,06 a -0,01); breaks no tempo sedentário associou-se positivamente com a força de preensão manual (β=0,06; IC 95% 0,01-0,12). Observou-se que o teste de força preensão manual apresentou melhor sensibilidade e especificidade para identificar a OOS (0,65 e 0,82), respectivamente, e que idosos com baixo desempenho nesse teste tem maior risco de apresentarem OOS (HR: 3,31; IC 95% 1,12-9,72). Foi observada associação inversa entre a prática de AFH total e OOS (RP: 2,56; IC 95% 1,03-6,35). A prática de exercício físico no lazer está inversamente associada ao desempenho físico (β:0,88; IC 95% 0,31-1,46) e a dependência nas AVDS (β:-1,05; IC 95% -1,64; -0,45), bem como a AFH total (β:-1,03; IC 95% -1,93; -0,13) está inversamente associada à dependência nas AVDS em mulheres idosas com OOS. Além disso, mulheres com OS que permaneceram insuficientemente ativas ao longo de todo o período de seguimento nos domínios exercício físico no lazer (HR: 2,28; IC 95% 1,04-4,99), e locomoção (HR: 2,62; IC 95% 1,28-5,36) apresentaram risco para incapacidade funcional. Conclusão. A prática de atividade física no domínio locomoção está inversamente associada à incidência de OS em idosos. Além disso, o risco de incapacidade funcional é maior em idosos com OS insuficientemente ativos em todos os domínios investigados. Padrões sedentários estão associados com a DMO e força muscular em idosos com osteopenia ou osteoporose. A aplicação do teste de força de preensão manual, um teste simples e de baixo custo, pode ser um instrumento alternativo para identificação de OOS em idosos para ser utilizado em serviços de saúde e pesquisas a campo. A prática de AF está inversamente associada à OOS, e mulheres com a presença do agravo insuficientemente ativas nos domínios exercício físico no lazer, e locomoção apresentaram maior risco para incapacidade funcional.
Introduction. Sarcopenia and SO are risk factors for osteosarcopenic obesity (OSO), that was described as the coexistence of three unfavorable conditions of body composition (sarcopenia, obesity and osteopenia/osteoporosis), which may result in a more aggravating condition to reduce physical function, risk of falls, fractures, hospitalizations and functional disability. Regular physical activity (PA) attenuates the loss of muscle mass and strength, contributes to the prevention and treatment of sarcopenia, SO and, consequently, the OSO, as well as functional disability. Objective. To analyze, after 24 months of follow-up, the association of the PA and of the sedentary behavior with sarcopenia, SO, OSO and functional disability in older adults. Methods. The final sample of the study was composed of 211 older adults of both sexes, aged between 60 and 93 years (72±7 years), 72% women, residents of the municipality of Presidente Prudente, São Paulo. The variables were: i) body composition by Dual Energy X-Ray Absorptiometry (DXA) ii) handgrip strength measured by digital dynamometer iii) level of PA and sedentary behavior (questionnaire and accelerometer), iv) physical performance tests (physical tests), and v) control variables [chronic noncommunicable diseases (NCDs), age, sex, ethnicity, income and smoking (self-reported)]. Results. It was verified that the older adults, over the follow-up period, presented low muscle mass (HR: 3.71, 95% CI 1.15-11.96), low gait speed (HR: 4.15, 95% CI 1.38-12.50), as well as excess body fat (HR: 3.82, 95% CI 1.18-12.37), and who remained insufficiently active in the locomotion domain had a higher risk for OS. The risk for functional disability was higher in older adults with sarcopenia who remained insufficiently active in the physical exercise (HR: 1.94, 95% CI 1.03-3.63), and locomotion (HR: 2.67, 95% CI 1.46-4.88) domains, as well as for the practice of total HPA (HR: 2.25; 95% CI 1.06- 4.75). For those with OS that remained insufficiently active in the three domains, the values were: occupational (HR: 2.40, 95% CI 1.15-5.00), physical exercise in leisure time (HR: 1.94, 95% CI: 1.03-3.65), locomotion (HR: 2.44, 95% CI 1.33-4.47), and for the practice total HPA (HR: 2.60; 95% CI 1.26-5.37). In the older adults with osteopenia/osteoporosis, the following correlations were found: bouts >60 min negatively associated with spine bone mineral density (BMD) (β=-0.03; 95% CI -0.06 to -0.01); breaks in the sedentary time were positively associated with handgrip strength (β=0.06; 95% CI 0.01-0.12). It was observed that the handgrip strength test presented a better sensitivity and specificity to identify OOS (0.65 and 0.82), respectively, and that older adults with poor performance in this test had a higher risk of OOS (HR: 3.31; 95% CI 1.12-9.72). An inverse association was observed between the practice of total HPA and OOS (RP: 2.56; 95% CI 1.03-6.35). The practice of physical exercise in leisure is inversely associated with physical performance (β:0.88, 95% CI 0.31-1.46) and dependence in the ADL (β:-1.05, 95% CI -1, 64; -0.45), as well as total HPA (β:-1.03; 95% CI -1.93; -0.13) is inversely associated with dependence in the ADL in older women with OOS. In addition, older women with OS who remained insufficiently active, over the follow-up period, in the domains physical exercise in leisure (HR: 2.28, 95% CI 1.04-4.99), and locomotion (HR: 2.62; 95% CI 1.28-5.36) presented a risk for functional disability. Conclusion. The practice of physical activity in the locomotion domain is inversely associated with the incidence of OS in the older adults. In addition, the risk of functional disability is greater in older adults with OS insufficiently active in all domains investigated. Sedentary patterns are associated with BMD and muscle strength in the older adults with osteopenia or osteoporosis. The application of the handgrip strength test, a simple and low cost test, may be an alternative instrument for identifying OOS in the older adults to be used in health services and field research. The practice of PA is inversely associated with OOS, and women with the presence this condition and insufficiently active in the domains physical exercise in the leisure, and locomotion presented greater risk for functional disability.
Introduction. Sarcopenia and SO are risk factors for osteosarcopenic obesity (OSO), that was described as the coexistence of three unfavorable conditions of body composition (sarcopenia, obesity and osteopenia/osteoporosis), which may result in a more aggravating condition to reduce physical function, risk of falls, fractures, hospitalizations and functional disability. Regular physical activity (PA) attenuates the loss of muscle mass and strength, contributes to the prevention and treatment of sarcopenia, SO and, consequently, the OSO, as well as functional disability. Objective. To analyze, after 24 months of follow-up, the association of the PA and of the sedentary behavior with sarcopenia, SO, OSO and functional disability in older adults. Methods. The final sample of the study was composed of 211 older adults of both sexes, aged between 60 and 93 years (72±7 years), 72% women, residents of the municipality of Presidente Prudente, São Paulo. The variables were: i) body composition by Dual Energy X-Ray Absorptiometry (DXA) ii) handgrip strength measured by digital dynamometer iii) level of PA and sedentary behavior (questionnaire and accelerometer), iv) physical performance tests (physical tests), and v) control variables [chronic noncommunicable diseases (NCDs), age, sex, ethnicity, income and smoking (self-reported)]. Results. It was verified that the older adults, over the follow-up period, presented low muscle mass (HR: 3.71, 95% CI 1.15-11.96), low gait speed (HR: 4.15, 95% CI 1.38-12.50), as well as excess body fat (HR: 3.82, 95% CI 1.18-12.37), and who remained insufficiently active in the locomotion domain had a higher risk for OS. The risk for functional disability was higher in older adults with sarcopenia who remained insufficiently active in the physical exercise (HR: 1.94, 95% CI 1.03-3.63), and locomotion (HR: 2.67, 95% CI 1.46-4.88) domains, as well as for the practice of total HPA (HR: 2.25; 95% CI 1.06- 4.75). For those with OS that remained insufficiently active in the three domains, the values were: occupational (HR: 2.40, 95% CI 1.15-5.00), physical exercise in leisure time (HR: 1.94, 95% CI: 1.03-3.65), locomotion (HR: 2.44, 95% CI 1.33-4.47), and for the practice total HPA (HR: 2.60; 95% CI 1.26-5.37). In the older adults with osteopenia/osteoporosis, the following correlations were found: bouts >60 min negatively associated with spine bone mineral density (BMD) (β=-0.03; 95% CI -0.06 to -0.01); breaks in the sedentary time were positively associated with handgrip strength (β=0.06; 95% CI 0.01-0.12). It was observed that the handgrip strength test presented a better sensitivity and specificity to identify OOS (0.65 and 0.82), respectively, and that older adults with poor performance in this test had a higher risk of OOS (HR: 3.31; 95% CI 1.12-9.72). An inverse association was observed between the practice of total HPA and OOS (RP: 2.56; 95% CI 1.03-6.35). The practice of physical exercise in leisure is inversely associated with physical performance (β:0.88, 95% CI 0.31-1.46) and dependence in the ADL (β:-1.05, 95% CI -1, 64; -0.45), as well as total HPA (β:-1.03; 95% CI -1.93; -0.13) is inversely associated with dependence in the ADL in older women with OOS. In addition, older women with OS who remained insufficiently active, over the follow-up period, in the domains physical exercise in leisure (HR: 2.28, 95% CI 1.04-4.99), and locomotion (HR: 2.62; 95% CI 1.28-5.36) presented a risk for functional disability. Conclusion. The practice of physical activity in the locomotion domain is inversely associated with the incidence of OS in the older adults. In addition, the risk of functional disability is greater in older adults with OS insufficiently active in all domains investigated. Sedentary patterns are associated with BMD and muscle strength in the older adults with osteopenia or osteoporosis. The application of the handgrip strength test, a simple and low cost test, may be an alternative instrument for identifying OOS in the older adults to be used in health services and field research. The practice of PA is inversely associated with OOS, and women with the presence this condition and insufficiently active in the domains physical exercise in the leisure, and locomotion presented greater risk for functional disability.
Descrição
Palavras-chave
Atividades de vida diária, Composição corporal, Força muscular, Funcionalidade, Massa muscular, Osteoporose, Activities of daily living, Body composition, Muscle strength, Functionality, Muscle mass, Osteoporosis