Interventions to ameliorate reductions in muscle quantity and function in hospitalised older adults: a systematic review towards acute sarcopenia treatment

John, Gladman; Welsh, Carly; Majid, Z.; Masud, Tahir; Jackson, Thomas; Grieg, Carolyn

Abstract

Objective: Assimilate evidence for interventions to ameliorate negative changes in physical performance, muscle strength, and muscle quantity in hospitalised older adults.

Methods: We searched for articles using MEDLINE, Embase, CINAHL, and Cochrane library using terms for randomised controlled trials, older adults, hospitalisation, and change in muscle quantity, strength, or physical performance. Two independent reviewers extracted data and assessed risk of bias. We calculated standardised mean differences for changes in muscle function/quantity pre- and post-intervention.

Results: We identified 9805 articles; 9614 were excluded on title/abstract; 147 full texts were excluded. We included 44 studies including 4522 participants; mean age 79.1. Twenty-seven studies (n=3417) involved physical activity interventions; a variety were trialled. Eleven studies involved nutritional interventions (n=676). One trial involved testosterone (n=39), two involved Growth Hormone (n=53), one involved nandrolone (n=29), and another involved erythropoietin (n=141). Three studies (n=206) tested Neuromuscular Electrical Stimulation. Evidence for effectiveness/efficacy was limited. Strongest evidence was for multi-component physical activity interventions. However, all studies exhibited at least some concerns for overall risk of bias, and considering inconsistencies of effect sizes across studies, certainty around true effect sizes is limited.

Conclusion: There is currently insufficient evidence for effective interventions to ameliorate changes in muscle function/quantity in hospitalised older adults. Multiple interventions have been safely trialled in heterogeneous populations across different settings. Treatment may need to be stratified to individual need. Larger scale studies testing combinations of interventions are warranted. Research aimed at understanding pathophysiology of acute sarcopenia will enable careful risk stratification and targeted interventions.
Registration: The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) – CRD42018112021.

Citation

John, G., Welsh, C., Majid, Z., Masud, T., Jackson, T., & Grieg, C. (2021). Interventions to ameliorate reductions in muscle quantity and function in hospitalised older adults: a systematic review towards acute sarcopenia treatment. Age and Ageing, 50(2), 394-404. https://doi.org/10.1093/ageing/afaa209

• Journal Article Type: Article
• Acceptance Date: Jul 27, 2020
• Online Publication Date: Oct 24, 2020
• Publication Date: 2021-03
• Deposit Date: Jul 30, 2020
• Publicly Available Date: Oct 25, 2021
• Journal: Age and Ageing
• Print ISSN: 0002-0729
• Electronic ISSN: 1468-2834
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 50
• Issue: 2
• Pages: 394-404
• DOI: https://doi.org/10.1093/ageing/afaa209
• Public URL: https://nottingham-repository.worktribe.com/output/4796075
• Publisher URL: https://academic.oup.com/ageing/advance-article/doi/10.1093/ageing/afaa209/5937554
• Additional Information: This is a pre-copyedited, author-produced version of an article accepted for publication in Age and Ageing following peer review. The version of record Carly Welch, Zeinab Majid, Carolyn Greig, John Gladman, Tahir Masud, Thomas Jackson, Interventions to ameliorate reductions in muscle quantity and function in hospitalised older adults: a systematic review towards acute sarcopenia treatment, Age and Ageing, , afaa209 is available online at: https://doi.org/10.1093/ageing/afaa209