7. Healthy Ageing is the process of developing and
maintaining the functional ability that enables well-
being in older age
World report on ageing and health, 2015
8. 功能退化比多種疾病更可怕 !
Landi et al, Journal of Clinical Epidemiology 63 (2010) 752-759
生活可以自理, 無多重慢性病
生活可以自理, 有多重慢性病
生活無法完全自理, 無多重慢性病
生活無法完全自理, 有多重慢性病
23. Diagnostic algorithm of
Asian Working Group for Sarcopenia
L.-K. Chen et al, JAMDA 15 (2014) 95-101
握力: <26 kg(men) and <18 kg
(women)
步速 : <0.8 m/s
骨骼肌量:
DXA: <7.0 kg/m2(men) and
<5.4 kg /m2 (women) ,
BIA: <7.0 kg/m2(men) and
<5.7 kg /m2 (women) ,
35. Standards of Medical Care in Diabetes 2017
AGS and ADA consensus, 2012; ADA 2015
Healthy
<7.5%
>=3 chronic illness requiring medication
>2 IADL impairment;
Mild-moderate dementia
Hx of hypoglycemia
Fall risk
<8.0%
>2ADL impaired; Severe dementia
End-stage disease
(Long-term care facility)
<8.5%
36. Exercise and physical frailty
• Frailty phenotype: 握力, 走路速度, 活動量, 易疲
倦, 體重減輕
• Physical activity and frailty
- 64% of older people are considered sendentary
- High LTPA subjects: ↓ 80% risk of frailty compared to sedentary subjects
- Improve falls, ADLs, Quality of life for frail subjects
Savela et al, J Gerontol A Biol Sci Med Sci 2013;68:1433-8
Brach et al, J Am Geriatr Soc 2004;52:502-9
Peterson et al, J Gerontol A Biol Sci Med Sci 2009;64:61-68
Cadore et al, Age (Dordr) 2014;36:801-11.
Gine-Garriga et al, Arch Phys Med Rehabil 2014;95:753-69 e3.
• Low intensity/Power resistance Training, aerobic
exercise (V)
• Flexibility home programs/chair-based exercise alone (?)
37. Exercise and cognitive frailty
• Cognitive frailty:
- physical frailty/slow gait speed only + cognitive impairment,
without dementia
• Cognitive decline prevention in non-frail older adults
- Aerobic exercise (V)
- Resistance training (∆): brain plasticity, executive function
- Taichi
- Aerobic + Resistance: better than alone
• Mechanism: structural brain reserve↑, brain plasticity↑,
cerebral blood flow↑
38. Current recommendations of physical
activity for adults 65 and older (WHO)
•中強度運動150分/周
或 高強度運動75分/周
若可以達到中強度運動
300分/周或 高強度運動
150分/周效果更好
•每次至少10分鐘
•有跌倒風險時 增加平
衡訓練
•每周至少兩次肌力訓
練
•要活就要動! 循序漸進,
盡力而為!
40. Practical Guidelines of exercise training
• Resistance training program:
- 2-3 times/wk, 8-12 repetitions*2 sets (1min rest between 2 sets)
- Borg scale 15 was suggested to achieve progressively in 4 wk period
- Exercises should be realized in exercise rooms or at home under
supervision (at least in the beginning)
- Variable ankle weights can be used
• Aerobic exercise:
- Walking with change in pace, step-ups, stationary cycling
- 5- 10 mins/day -> 15-30 mins/day to achieve 150mins/wk
- Borg scale 12-14
42. Conclusion-
Suggestion about exercise to prevent
physical/cognitive frailty
• Multimodal physical activity programs
- resistance/power, aerobic and body and mind exercise
- at least twice a week
- during 30-45 min per session
- moderate to high intensity
• Goal:
- Identify optimal intensity, volume, frequency
- Improve neuromuscular, muscular, cardiovascular adaptation
48. Each additional nutrient deficiency
raised the risk of frailty in older
women by almost 10%
• Total carotenoids,
• Alpha-tocopherol,
• 25- hydroxyvitamin D
• Selenium
• Zinc
Semba et al, J Gerontol A Biol
Sci Med Sci. 2006;61:594-9
56. Social engagement decrease incident
disability
Social frailty
Increase disability
Makizako et al, J Am Med Dir Assoc. 2015 ;16:1003
Social engagement
decrease disability
Mendes de Leon et al, Am J Epidemiol 2003 ;157 :633-42