비만 노쇠와 복합 운동 = Obese Frailty and Combined Exercise

다국어 초록 (Multilingual Abstract)

PURPOSE: Frailty is a geriatric syndrome that impairs the health and quality of life of older adults. While unintended weight loss is known to be a primary risk factor for frailty, obesity has also been closely associated with frailty. Combined exercise is thought to be an effective way of resolving obesity and frailty, but studies demonstrating the effect of combined exercise on obese frailty are lacking. In this review, we seek to understand the relevant mechanisms by exploring prior studies on obese frailty, and provide the implications of appropriate combined exercise interventions for obese frailty.
METHODS: To collect data for this study, we used academic search systems such as Scopus, Google Scholar, PubMed, and Web of Science. The keywords used for the search were a combination of words such as ’obesity’, ‘frailty’, ‘combined or multicomponent exercise’, and ‘older or elderly adults’.
RESULTS: The results from the 16 selected articles confirmed that combined exercise reduces body weight, percentage of body fat, and risk of falls. Moreover, it improves muscle strength, balance, and walking function of the obese frail population.
CONCLUSIONS: As we have confirmed the positive outcomes on the combined exercise for obese frail older adults, an optimal exercise program needs to be presented. Older adults with obesity are recommended to exercise at least 2-3 times a week during the initial period. Further, they should begin with low-intensity walking, full-body exercise, balance, and flexibility exercises, then gradually increase the exercise volume. Moreover, to facilitate the positive outcomes of physical training and to encourage autonomy and enjoyment of exercise among obese frail older adults, a novel method and an individualized scientific exercise program need to be developed.

참고문헌 (Reference)

1 김다미, "최근 10년 간 거주 지역에 따른 한국 성인의 식생활 및 비만 유병률 변화 : 제4기(2007~2009)와 제7기(2016~2018) 국민건강영양조사 자료를 이용하여" 대한지역사회영양학회 26 (26): 37-47, 2021

2 Villareal DT, "Weight loss, exercise, or both and physical function in obese older adults" 364 (364): 1218-1229, 2011

3 Poggiogalle E, "Treatment of body composition changes in obese and overweight older adults : insight into the phenotype of sarcopenic obesity" 47 (47): 699-716, 2014

4 Hamrick MW, "The skeletal muscle secretome : an emerging player in muscle-bone crosstalk" 11 (11): 60-, 2012

5 Beavers DP, "The independent and combined effects of intensive weight loss and exercise training on bone mineral density in overweight and obese older adults with osteoarthritis" 22 (22): 726-733, 2014

6 Lord SR, "The effect of group exercise on physical functioning and falls in frail older people living in retirement villages : a randomized, controlled trial" 51 (51): 1685-1692, 2003

7 Elmahgoub SS, "The effect of combined exercise training in adolescents who are overweight or obese with intellectual disability : the role of training frequency" 25 (25): 2274-2282, 2011

8 Jin KL, "The critical need to promote research of aging and aging-related diseases to improve health and longevity of the elderly population" 6 (6): 1-5, 2015

9 Feng Z, "The coordinate regulation of the p53 and mTOR pathways in cells" 102 (102): 8204-8209, 2005

10 Blaum CS, "The association between obesity and the frailty syndrome in older women : The women's health and aging studies" 53 (53): 927-934, 2005

11 전덕영, "The Association between Frequency of Social Contact and Frailty in Older People: Korean Frailty and Aging Cohort Study (KFACS)" 대한의학회 33 (33): 1-8, 2018

12 Moreno-Franco B, "Socioeconomic determinants of sarcopenic obesity and frail obesity in community-dwelling older adults : The Seniors-ENRICA Study" 8 (8): 10760-, 2018

13 Serra-Rexach JA, "Short-term, light-to moderate-intensity exercise training improves leg muscle strength in the oldest old : a randomized controlled trial" 59 (59): 594-602, 2011

14 Carcaillon L, "Sex Differences in the association between serum levels of testosterone and frailty in an elderly population : the toledo study for healthy aging" 7 (7): e32401-, 2012

15 Crepaldi G, "Sarcopenia and osteoporosis : a hazardous duet" 28 (28): 66-68, 2005

16 Cruz-Jentoft AJ, "Sarcopenia" 393 (393): 2636-2646, 2019

17 Tilg H, "Role of adiponectin and PBEF/visfatin as regulators of inflammation : involvement in obesity-associated diseases" 114 (114): 275-288, 2008

18 Vendrell J, "Resistin, adiponectin, ghrelin, leptin, and proinflammatory cytokines : Relationships in obesity" 12 (12): 962-971, 2004

19 Nave H, "Resistance of janus kinase-2 dependent leptin signaling in natural killer(NK)cells : a novel mechanism of NK cell dysfunction in diet-induced obesity" 149 (149): 3370-3378, 2008

20 Villareal DT, "Regular multicomponent exercise increases physical fitness and muscle protein anabolism in frail, Obese, Older Adults" 19 (19): 312-318, 2011

21 Vlahopoulos S, "Recruitment of the androgen receptor via serum response factor facilitates expression of a myogenic gene" 280 (280): 7786-7792, 2005

22 Urano T, "Recent genetic discoveries in osteoporosis, sarcopenia and obesity" 62 (62): 475-484, 2015

23 Borras C, "RasGrf1 deficiency delays aging in mice" 3 (3): 262-276, 2011

24 Brunet A, "Protein kinase SGK mediates survival signals by phosphorylating the forkhead transcription factor FKHRL1(FOXO3a)" 21 (21): 952-965, 2001

25 Liu CJ, "Progressive resistance strength training for improving physical function in older adults" (3) : CD002759-, 2009

26 Buchner DM, "Preventing frail health" 8 (8): 1-17, 1992

27 Kojima G, "Prevalence of frailty in japan : a systematic review and meta-analysis" 27 (27): 347-353, 2017

28 Cunha RM, "Postexercise hypotension after aquatic exercise in older women with hypertension : a randomized crossover clinical trial" 31 (31): 247-252, 2018

29 Cadore EL, "Positive effects of resistance training in frail elderly patients with dementia after long-term physical restraint" 36 (36): 801-811, 2014

30 Gordon EH, "Physiological basis for sex differences in frailty" 6 : 10-15, 2018

31 Arita Y, "Paradoxical decrease of an adipose-specific protein, adiponectin, in obesity" 257 (257): 79-83, 1999

32 Izquierdo M, "Once weekly combined resistance and cardiovascular training in healthy older men" 36 (36): 435-443, 2004

33 Meyer MR, "Obesity, insulin resistance and diabetes : sex differences and role of oestrogen receptors" 203 (203): 259-269, 2011

34 Lohman MC, "Obesity, dietary inflammation, and frailty among older adults : evidence from the national health and nutrition examination survey" 38 (38): 18-32, 2019

35 Jensen GL, "Obesity in older adults : relationship to functional limitation" 13 (13): 46-51, 2010

36 Starr KNP, "Obesity and physical frailty in older adults : a scoping review of lifestyle intervention trials" 15 (15): 240-250, 2014

37 Bylow K, "Obese frailty, physical performance deficits, and falls in older men with biochemical recurrence of prostate cancer on androgen deprivation therapy : a case-control study" 77 (77): 934-940, 2011

38 Tremblay MS, "New canadian physical activity guidelines" 36 (36): 36-46, 2011

39 Smith GI, "Muscle protein synthesis response to exercise training in obese, older men and women" 44 (44): 1259-1266, 2012

40 Cadore EL, "Muscle power training : a hallmark for muscle function retaining in frail clinical setting" 19 (19): 190-192, 2018

41 Cadore EL, "Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenarians" 36 (36): 773-785, 2014

42 Mohler MJ, "Motor performance and physical activity as predictors of prospective falls in community-dwelling older adults by frailty level : application of wearable technology" 62 (62): 654-664, 2016

43 Hawley JA, "Molecular responses to strength and endurance training : are they incompatible?" 34 (34): 355-361, 2009

44 Brown M, "Low-intensity exercise as a modifier of physical frailty in older adults" 81 (81): 960-965, 2000

45 Hirani V, "Longitudinal associations between body composition, sarcopenic obesity and outcomes of frailty, disability, institutionalisation and mortality in community-dwelling older men : The Concord Health and Ageing in Men Project" 46 (46): 413-420, 2017

46 Midzak AS, "Leydig cell aging and the mechanisms of reduced testosterone synthesis" 299 (299): 23-31, 2009

47 Procaccini C, "Leptin as an immunomodulator" 33 (33): 35-45, 2012

48 Won CW, "Korean frailty and aging cohort study(KFACS) : cohort profile" 10 (10): e035573-, 2020

49 Soysal P, "Inflammation and frailty in the elderly : a systematic review and meta-analysis" 31 : 1-8, 2016

50 Salvioli S, "Immune system, cell senescence, aging and longevity-inflamm-aging reappraised" 19 (19): 1675-1679, 2013

51 OECD, "Health at a Glance 2017: OECD Indicators" OECD Publishing 2017

52 Karasik D, "Genetics of the musculoskeletal system : a pleiotropic approach" 23 (23): 788-802, 2008

53 Li HF, "Frailty, inflammation, and immunity" 2 (2): 466-473, 2011

54 Martins BA, "Frailty prevalence using frailty index, associated factors and level of agreement among frailty tools in a cohort of Japanese older adults" 84 : 2019

55 Khan M, "Frailty in trauma patients : an emerging geriatric syndrome" 5 (5): 30-, 2017

56 Rodriguez-Manas L, "Frailty in the clinical scenario" 385 (385): E7-E9, 2015

57 Fried LP, "Frailty in older adults : evidence for a phenotype" 56 (56): M146-M56, 2001

58 Wilson D, "Frailty and sarcopenia : The potential role of an aged immune system" 36 : 1-10, 2017

59 Hanlon P, "Frailty and pre-frailty in middle-aged and older adults and its association with multimorbidity and mortality : a prospective analysis of 493737 UK Biobank participants" 3 (3): E323-E332, 2018

60 Sandri M, "Foxo transcription factors induce the atrophy-related ubiquitin ligase atrogin-1 and cause skeletal muscle atrophy" 117 (117): 399-412, 2004

61 Stathokostas L, "Flexibility training and functional ability in older adults : a systematic review" 2012 : 306818-, 2012

62 Mankhong S, "Experimental models of sarcopenia : bridging molecular mechanism and therapeutic strategy" 9 (9): 1385-, 2020

63 Lee PG, "Exercise prescriptions in older adults" 95 (95): 425-432, 2017

64 Bray NW, "Exercise prescription to reverse frailty" 41 (41): 1112-1116, 2016

65 Smith EP, "Estrogen resistance caused by a mutation in the estrogen-receptor gene in a man" 331 (331): 1056-1061, 1994

66 Hakkinen A, "Effects of prolonged combined strength and endurance training on physical fitness, body composition and serum hormones in women with rheumatoid arthritis and in healthy controls" 23 (23): 505-512, 2005

67 Binder EF, "Effects of exercise training on frailty in community-dwelling older adults : results of a randomized, controlled trial" 50 (50): 1921-1928, 2002

68 Cadore EL, "Effects of different exercise interventions on risk of falls, gait ability, and balance in physically frail older adults : a systematic review" 16 (16): 105-114, 2013

69 Meng NH, "Effects of concurrent aerobic and resistance exercise in frail and pre-frail older adults a randomized trial of supervised versus home-based programs" 99 (99): e21187-, 2020

70 백경완, "Effects of Exercise on Physical Fitness and Strength According to the Frailty Level of Female Elderly with Hypertension" 한국운동생리학회 29 (29): 368-376, 2020

71 Jadczak AD, "Effectiveness of exercise interventions on physical function in community-dwelling frail older people : an umbrella review of systematic reviews" 16 (16): 752-775, 2018

72 Villareal DT, "Effect of weight loss and exercise on frailty in obese older adults" 166 (166): 860-866, 2006

73 Buckinx F, "Effect of high-intensity interval training combined with L-Citrulline supplementation on functional capacities and muscle function in dynapenic-obese older adults" 7 (7): 561-, 2018

74 Markofski MM, "Effect of age on basal muscle protein synthesis and mTORC1signaling in a large cohort of young and older men and women" 65 : 1-7, 2015

75 Watt JR, "Effect of a supervised hip flexor stretching program on gait in frail elderly patients" 3 (3): 330-335, 2011

76 Losa-Reyna J, "Effect of a short multicomponent exercise intervention focused on muscle power in frail and pre frail elderly : A pilot trial" 115 : 114-121, 2019

77 Veldhuis JD, "Differential impact of age, sex steroid-hormones, and obesity on basal versus pulsatile growth-hormone secretion in men as assessed in an ultrasensitive chemiluminescence assay" 80 (80): 3209-3222, 1995

78 Matheu A, "Delayed ageing through damage protection by the Arf/p53 pathway" 448 (448): 375-379, 2007

79 Jones GR, "Community exercise program for older adults recovering from hip fracture : a pilot study" 14 (14): 439-455, 2006

80 Baglietto L, "Circulating steroid hormone concentrations in postmenopausal women in relation to body size and composition" 115 (115): 171-179, 2009

81 Armamento-Villareal R, "Changes in thigh muscle volume predict bone mineral density response to lifestyle therapy in frail, obese older adults" 25 (25): 551-558, 2014

82 Travison TG, "Changes in reproductive hormone concentrations predict the prevalence and progression of the frailty syndrome in older men : the concord health and ageing in men project" 96 (96): 2464-2474, 2011

83 Shi SM, "Changes in predictive performance of a frailty index with availability of clinical domains" 68 (68): 1771-1777, 2020

84 Kadi F, "Cellular and molecular mechanisms responsible for the action of testosterone on human skeletal muscle. A basis for illegal performance enhancement" 154 (154): 522-528, 2008

85 Fern AK, "Benefits of physical activity in older adults programming modifications to enhance the exercise experience" 13 (13): 12-16, 2009

86 Okura T, "Association of polymorphisms in the estrogen receptor alpha gene with body fat distribution" 27 (27): 1020-1027, 2003

87 Landre B, "Association between life-course obesity and frailty in older adults : findings in the GAZEL cohort" 28 (28): 388-396, 2020

88 Yang YJ, "An overview of the molecular mechanisms contributing to musculoskeletal disorders in chronic liver disease : osteoporosis, sarcopenia, and osteoporotic sarcopenia" 22 (22): 2604-, 2021

89 Garber CE, "American college of sports medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise" 43 (43): 1334-1359, 2011

90 American College of Sports M, "American college of sports medicine position stand. Exercise and physical activity for older adults" 41 (41): 1510-1530, 2009

91 Shaw AC, "Aging of the innate immune system" 22 (22): 507-513, 2010

92 Byrne C, "Ageing, muscle power and physical function : a systematic review and implications for pragmatic training interventions" 46 (46): 1311-1332, 2016

93 Colleluori G, "Aerobic plus resistance exercise in obese older adults improves muscle protein synthesis and preserves myocellular quality despite weight loss" 30 (30): 261-273, 2019

94 Villareal DT, "Aerobic or resistance exercise, or both, in dieting obese older adults" 376 (376): 1943-1955, 2017

95 Siiteri PK, "Adipose-Tissue as a Source of Hormones" 45 (45): 277-282, 1987

96 Tilg H, "Adipocytokines : mediators linking adipose tissue, inflammation and immunity" 6 (6): 772-783, 2006

97 Tanaka K, "Active vitamin d possesses beneficial effects on the interaction between muscle and bone" 450 (450): 482-487, 2014

98 Park SW, "Accelerated loss of skeletal muscle strength in older adults with type 2 diabetes-the health, aging, and body composition study" 30 (30): 1507-1512, 2007

99 Thompson PD, "ACSM's new preparticipation health screening recommendations from ACSM's guidelines for exercise testing and prescription, ninth edition" 12 (12): 215-217, 2013

100 Latham NK, "A randomized, controlled trial of quadriceps resistance exercise and vitamin D in frail older people : the frailty interventions trial in elderly subjects(FITNESS)" 51 (51): 291-299, 2003