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Файл:Frailty syndrome clinic, diagnosis, treatment. Study aid
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Mathematical model of the risk of developing severe sarcopenia
Picture 5 — ROC-curve for a mathematical model
of the risk of developing severe sarcopenia
Formula: 6.79 – 1.09*(phase angle) + 0.14*(SMM fraction) +
0.71*(Appendicular SMM) – 4.99*(Appendicular SMM index) +
0.26*(Walking time at a distance of 4 meters) + 0.88*(erythrocytes)
Sensitivity 97.6 %, specificity 84.4 %. Area under the curve (AUC)
0.96. The overall reliability of the model is 94.4 %. The resulting model for
the risk of developing severe sarcopenia is characterized by high sensitivity,
good specificity, high information content and high reliability (Picture 5).
For the first time we have received certificates of state registration of
computer programs, confirming the priority of:
1. Certificate of state registration of the computer program No.
2022611090 Russian Federation. Program for assessing the risk of
development of confirmed sarcopenia in elderly and senile patients with
polymorbid pathology: No. 2021682442: Appl. 12/26/2021: publ.
19.01.2022 / V.V. Petrenko, S.V. Bulgakova, D.P. Kurmaev.
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2. Certificate of state registration of the computer program No.
2022610772 Russian Federation. Program for assessing the risk of
developing severe sarcopenia in elderly and senile patients with polymorbid
pathology: No. 2021682432: Appl. 12/26/2021: publ. 17.01.2022 /
V.V. Petrenko, S.V. Bulgakova, D.P. Kurmaev.
3. Certificate of state registration of the computer program No.
2022610746 Russian Federation. Program for assessing the risk of
developing senile asthenia in elderly and senile patients with polymorbid
pathology: No. 2021682480: Appl. 12/26/2021: publ. 14.01.2022 /
V.V. Petrenko, S.V. Bulgakova, D.P. Kurmaev.
The above software products are widely used in practical healthcare to
predict the risks of developing confirmed sarcopenia, severe sarcopenia, and
senile asthenia in elderly and senile patients with polymorbid pathology.
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14. PREVENTIVE COUNSELING OF PATIENTS
(RECOMMENDATIONS ON PHYSICAL ACTIVITY AND RATIONAL
NUTRITION FOR PEOPLE OVER 65 YEARS OF AGE)
14.1. PHYSICAL ACTIVITY RECOMMENDATIONS
For people of the older age group, physical activity is no less useful
than for young people. Physically active retirees have better cardiovascular
and respiratory health, better memory and mental performance, better
coordination, less risk of falls, and lower all-cause mortality.
In addition, regular exercise helps fight depression. Among the types
of physical activity recommended for seniors are walking, cycling, dancing,
yoga, swimming, jogging, basketball, football, tennis, badminton, strength
training, balance and stretching exercises, and equestrian sports.
The presence of chronic diseases is not a contraindication for exercise.
However, older people should be careful about their well-being. To plan
classes and monitor the patient's condition, it is necessary to know the levels
of physical activity, assess the level of physical activity of the patient and
exclude (or identify) contraindications for intensive physical activity.
Physical Activity Levels:
• Lack of physical activity — corresponds to a state of rest, for
example, when a person is sleeping or lying down reading or watching
television. In this case, energy costs range from 1.1 to 2.9 kcal/min.
• Moderate physical activity is a level of physical activity that raises
your heart rate slightly and leaves you feeling warm and slightly out of
breath, such as the effort of a healthy person to walk briskly, swim, ride a
bike on a flat surface, dance. This load is accompanied by energy burning
from 3.5 to 7.0 kcal/min.
• Intense physical activity is a level of physical activity that
significantly increases the heart rate and causes sweat and severe shortness
of breath (“out of breath”), for example, the effort expended by a healthy
person in running, chopping wood, aerobics, swimming on distance, fast
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cycling, uphill. At the same time, energy costs are equal to six metabolic
equivalents (7 kcal/min) and more.
In order to determine the level of physical activity, it is necessary to
calculate the maximum heart rate: maximum heart rate = 220 — age and
determine the desired heart rate according to table 6.
Table 6
Desired heart rate by age
Age
Maximum
heart rate
Moderate physical
activity (55–70 % of
maximum heart rate)
Intense physical activity
(70–85 % of maximum
heart rate)
beats per
minute
In 15
seconds
beats per
minute
In 15
seconds
30
190
105–133
26–33
133–162
33–41
40
180
99–126
25–32
126–153
32–38
50
170
94–119
24–30
119–145
30–36
60
160
88–112
22–28
112–136
28–34
70
150
83–105
21–26
105–128
26–32
80
140
77–98
19–25
98–119
25–30
Questionnaire for assessing the level of physical activity
(the numbers opposite the questions correspond
to the number of points)
It is necessary to ask the patient to choose statements that are
characteristic of him.
1. I do not engage in vigorous or moderate physical activity on a
regular basis and do not intend to start in the next 6 months.
2. I do not engage in vigorous or moderate physical activity on a
regular basis, but I am thinking about starting in the next 6 months.
3. I'm trying to get into vigorous or moderate physical activity but don't
do it regularly.
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4. I engage in vigorous physical activity less than 3 times a week (or)
moderate physical activity less than 5 times a week.
5. I have been doing moderate physical activity for 30 minutes a day,
5 days a week for the last 1–5 months.
6. I have been doing moderate physical activity for 30 minutes a day,
5 days a week for the past 6 (or more) months.
7. I do intense physical activity 3 or more times a week for 1–5 months.
8. I have been involved in vigorous physical activity 3 or more times
a week for the past 6 (or more) months.
Evaluation of results
• 1 point — physically inactive and not intending to exercise;
• 2–4 points reflective — those who are trying to increase their level
of FA or thinking about it;
• 5 points and above — physically active.
Physical activity risk questionnaire
Has a doctor ever told you that you have a heart condition and advised
you to only engage in physical activity under medical supervision?
Have you had chest pain in the past month?
Do you have chest pain during exercise?
Do you have a tendency to faint or fall from dizziness?
Do you have bone or joint problems that can be aggravated by physical
activity?
Has a doctor ever recommended medication for high blood pressure or
heart disease?
Do you have any reasons, based on your own experience or the advice
of a doctor, not to engage in physical activity without medical supervision?
It is necessary to ask the patient to choose statements that are
characteristic of him. Evaluation of results
• if there is at least one positive answer, it is necessary to resolve the
issue of additional examination before the start of intense and moderate
physical activity.
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The minimum level of physical activity is the level required to receive
health benefits. It is achieved with regular moderate-to-high intensity
exercise, which consumes a total of 150 kcal per day, which corresponds to
an energy expenditure of about 1000 kcal per week with daily exercise. All
adults should avoid a sedentary lifestyle.
A little physical activity is better than no physical activity at all, and
adults who are even slightly physically active reap health benefits. Adults
should engage in 2 days or more of moderate physical activity per week to
strengthen the muscular system, involving all muscle groups. The duration
of one session of aerobic physical activity should be at least 10 minutes and
preferably evenly distributed throughout the week.
The doctor determines the level of physical activity of the patient and
his attitude to classes:
- physically inactive and not intending to exercise (1 point on the rating
scale);
- thinking — those who are trying to increase their level of functional
activity or thinking about it (2–4 points);
- physically active (5 points and above).
And depending on this, the doctor must decide which of the three
possible individual plans to follow at this stage: “get out of your chair”,
“plan the first stage”, “stay physically active”.
For patients with senile asthenia syndrome, it is recommended:
- moderate-intensity aerobic exercise for at least 150 minutes per
week;
- balance exercises 3 or more days a week;
- strength exercises — 2 or more days a week.
Loads with a training pulse of 50–75 % of the maximum heart rate are
recommended. The maximum age-related heart rate is determined by the
formula 220 beats per minute minus age.
Older people who have been sedentary for a long time should start
exercising slowly, starting with a few minutes a day, and build up gradually.
If older people cannot perform the recommended amount of physical
activity, exercise according to their abilities and health status. If you feel
worse, classes should be stopped or stopped for a while.
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Lesson structure
Physical activity should include a warm-up (warm-up), an active
period and a cool-down period. Warm-up (warm-up) — usually lasts from
5 to 10 minutes. The warm-up may consist of light stretching, light
calisthenics, or low-intensity exercise (such as walking or slow cycling).
This is a very important transitional phase, allowing the
musculoskeletal, cardiovascular and respiratory systems to prepare for
physical activity.
The active phase is the cardiovascular or aerobic phase. Lasts
20–60 minutes.
Cooling down period — usually lasts from 5 to 10 minutes. As with
the warm-up, low-intensity exercises such as walking or stretching can be
used. This period is important to prevent a decrease in pressure with a sharp
interruption of physical activity.
Basic principles of optimizing physical activity
• recommendations to the patient should be given taking into account
the characteristics and needs of various social groups:
- it is necessary to recommend to the patient the type of physical
activity that is available to him and brings pleasure;
- offering multiple types of physical activity can also increase patients'
enjoyment and support their efforts;
- it is necessary to keep the patient from starting classes with
unrealistic types of physical exercises (for example, too intense or unusual
for their lifestyle);
• patients of all ages can improve their quality of life through daily
moderate physical activity;
• before recommending certain types of physical activity, the doctor
must convince the patient that for him personally there are specific reasons
for engaging in which physical activity benefits those who engage in it
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(reducing the risk of developing coronary heart disease, arterial
hypertension, diabetes mellitus, stroke; improvement in the ratio of
lipoproteins (reduction of total cholesterol, triglycerides in the blood serum
and an increase in the proportion of high-density lipoproteins; weight loss
and prevention of obesity; reduction in bone loss: in young women, physical
activity reduces the risk of developing osteoporosis, in women in
postmenopausal slows down the demineralization of bones, etc.);
• frequency of classes — 3 times a week is considered optimal;
• the duration of the lesson is 20–60 minutes;
• the intensity of the load is controlled by the maximum heart rate;
recommended exercise mode: moderate intensity (from 50 to 70 % of the
maximum heart rate) or intensive (70 % of the maximum heart rate and
more)
Individual recommendations
• If the patient is in the “Not having the intention to get out of their
chair” group, the clinician should help the patient identify the potential
benefits of physical activity, determine the reasons why he does not engage
in it. The doctor gives advice to think about getting physical activity.
• if the patient belongs to the group “Thinking — Planning the first
step” — the patient plans the type, place, time, duration of classes and social
support, the doctor praises the patient and writes down the plan (frequency,
duration, intensity, type).
• if the patient belongs to the group “Physically active — Don't lose
pace” — the doctor praises the patient, analyzes the patient's level of
physical activity and makes recommendations; both discuss possible
barriers to physical activity.
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14.2. PRINCIPLES OF RATIONAL NUTRITION
FOR PEOPLE OVER 65 YEARS OF AGE
On average, an elderly person, especially those with senile asthenia
syndrome, needs a protein intake of about 1 r/kg/day, but not more than
100 g/day. To do this, you need to eat 2–3 servings of dairy products and
2 servings of meat products per day.
In addition, for a balanced diet, you need to eat 5–7 servings of
carbohydrates, 4–5 servings of vegetables, 2–3 servings of fruits, and
1–2 servings of fat per day. The volume of fluid consumed is 6-8 glasses per
day, i.e. 1–1.5 l. in a day. Water is not recommended to limit even in patients
with heart failure and edema.
In the presence of dysphagia, food should be of a homogeneous, pureelike consistency, and the liquid should be thicker (jelly, curdled milk).
Bread, cereals and pasta, rice and potatoes can be eaten at every meal —
these foods are an important source of protein, carbohydrates, fiber and
minerals (potassium, calcium, magnesium) and vitamins (C, folic acid,
carotenoids).
Most varieties of bread, especially wholemeal bread, cereals and
potatoes contain various types of dietary fiber — fiber. Consuming enough
of these foods plays an important role in the normalization of bowel function
and can reduce the symptoms of chronic constipation, diverticulitis,
hemorrhoids, as well as reduce the risk of coronary heart disease and certain
types of cancer.
Dairy products that are low in fat and salt (kefir, sour milk, cheese,
yogurt) should be consumed daily — they are rich in protein and calcium.
Vegetable intake should exceed fruit intake by approximately 2:1. The
use of vegetables and fruits compensates for the deficiency of antioxidants
(carotenoids, vitamins C and E).
Legumes, peanuts, bread, green vegetables such as spinach, Brussels
sprouts and broccoli are a source of folic acid, which plays an important role
in reducing risk factors associated with the development of cardiovascular
disease, cervical cancer, and anemia. The availability of fresh fruits and
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vegetables varies by season and region, but frozen, dried and specially
processed vegetables and fruits are available throughout the year. It is
recommended to give preference to seasonal products grown locally.
You should limit the consumption of “visible fat” in cereals and
sandwiches, choose meat and dairy products with a low fat content.
It is recommended to replace high-fat meats and meat products with
legumes, fish, poultry, and lean meats. Legumes, meat, poultry are an
important source of protein. The number of sausages, sausages, red meat
should be limited.
You should limit the consumption of sugars: sweets, confectionery,
dessert. Foods high in refined sugars are a source of energy but contain little
to no nutrients.
The total intake of table salt, taking into account its content in bread,
canned food and other products, should not exceed 1 teaspoon (6 grams) per
day. Table salt is found naturally in foods, usually in small amounts. High
blood pressure is associated with excess salt intake.
Recommendations for the public to reduce salt intake include the
following tips: Avoid foods high in salt (canned, salted, smoked); — before
you automatically add salt to food, you should first taste it, and it is better
not to add salt at all.
Preference should be given to cooking products by steaming, by
boiling, baking. Reduce the addition of fats, oils, salt, sugar in the cooking
process. When cooking, it is recommended to use spices.
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