Exercise and Nutrition Strategies to Counteract Sarcopenic Obesity.

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metabolic syndrome 1 endocrinologydiseases
obesity 92 endocrinologydiseases
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testosterone 10658 ectopic lipid deposition [[36]]. In addition, hormonal changes, such as a decrease in growth hormone and testosterone secretion, reduced thyroid hormone responsiveness, and leptin resistance, are commonly seen with age
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metabolic syndrome 27418 the waist circumference, and it improved blood pressure, the latter being important for improving the metabolic syndrome . Specifically in a sarcopenic obese population, electrostimulation was compared with a control group
obesity 1196 limitations. The decrease in skeletal muscle mass and function (sarcopenia) and the increase in fat mass ( obesity ) are important contributors to the development of physical limitations, which aggravates the chronic
obesity 1399 chronic diseases prognosis. The combination of the two conditions, which is referred to as sarcopenic obesity , amplifies the risk for these negative health outcomes, which demonstrates the importance of preventing
obesity 1539 negative health outcomes, which demonstrates the importance of preventing or counteracting sarcopenic obesity . One of the main challenges is the preservation of the skeletal muscle mass and function, while simultaneously
obesity 1820 nutrition are two key components in the development, as well as the prevention and treatment of sarcopenic obesity . The main aim of this narrative review is to summarize the different, both separate and combined, exercise
obesity 2006 separate and combined, exercise and nutrition strategies so as to prevent and/or counteract sarcopenic obesity . This review therefore provides a current update of the various exercise and nutritional strategies
obesity 3475 major contributor to physical limitations in older adults [[5]]. The coexistence of sarcopenia and obesity , known as sarcopenic obesity, have an even more detrimental effect on physical limitation, as they act
obesity 3504 physical limitations in older adults [[5]]. The coexistence of sarcopenia and obesity, known as sarcopenic obesity , have an even more detrimental effect on physical limitation, as they act in a synergistic manner [[6],[7]].
obesity 3645 effect on physical limitation, as they act in a synergistic manner [[6],[7]]. Furthermore, sarcopenic obesity has also been reported to increase the risk for metabolic disturbances, which is detrimental for several
obesity 3845 for several cardio-metabolic chronic diseases [[8]]. The prevention and/or treatment of sarcopenic obesity is therefore of major relevance for public health and individual healthy aging. Exercise strategies
obesity 4030 aging. Exercise strategies have been largely linked to improvements in the parameters of sarcopenia and obesity . Additionally, nutritional strategies have the potential to the improve body composition parameters
obesity 4343 update of the various exercise and nutritional strategies, so as to prevent and/or counteract sarcopenic obesity in older adults.2. Methods Narrative ReviewPubMed and Google Scholar were searched in order to identify
obesity 4649 strategy consisted of the Boolean operator “AND”, so as to combine the following concepts:Sarcopenic obesity , body composition, and agingNutrition and dietExercise and physical activityAll of the relevant keyword
obesity 5078 improving the body composition and physical performance parameters that were related to sarcopenic obesity . Acute (one-day) studies were not included. Studies with older adults were included, which were defined
obesity 5323 55 years old. Both English and Dutch articles were included.3. Defining Sarcopenic ObesitySarcopenic obesity has been defined as a combination of low skeletal muscle mass and high fat mass or bodyweight, which
obesity 5582 used for both of the conditions [[9]]. Different methods are used to characterize both sarcopenia and obesity . For instance, obesity has been defined using the body mass index (BMI), skinfold measurements, or fat
obesity 5605 conditions [[9]]. Different methods are used to characterize both sarcopenia and obesity. For instance, obesity has been defined using the body mass index (BMI), skinfold measurements, or fat mass [[10],[11],[12],[13],[14]],
obesity 5915 muscle mass, combined with force and/or performance [[4],[17]].Difficulties with defining sarcopenic obesity have been mainly as a result of contrasting body composition changes. While body weight and BMI remain
obesity 6225 (visceral) fat mass is increased [[4]]. The sole use of weight or BMI the for diagnoses of sarcopenic obesity can therefore lead to a misinterpretation of the condition [[18]]. Potentially, misaligned treatment
obesity 6439 methods may be applied, which may lead to a worsening of the condition. Importantly, defining sarcopenic obesity should always include a combination of methods, including measuring body fat, skeletal muscle mass,
obesity 6592 methods, including measuring body fat, skeletal muscle mass, and ideally also muscle strength. Sarcopenic obesity is an age-related disease and will therefore, in this review, be defined as present in older adults,
obesity 6790 older adults, which includes individuals at the age of 55 years and older.The prevalence of sarcopenic obesity varies according to the definitions and the methods that are used for this definition. Using the dual-energy
obesity 6964 for this definition. Using the dual-energy X-ray absorptiometry (DXA), the prevalence of sarcopenic obesity was 2% between individuals 60–69 years of age, and 10% for individuals over 80 years of age [[10]].
obesity 7382 prevalence in the U.S. population, from 16% to 40% [[20]].These differences in defining the sarcopenic obesity leads to difficulties in comparing the effectiveness of the strategies that target the sarcopenic obesity.
obesity 7488 obesity leads to difficulties in comparing the effectiveness of the strategies that target the sarcopenic obesity . Therefore, this review focuses primarily on the improvements in skeletal muscle mass, muscle strength,
obesity 7737 waist circumference, which are the parameters that are considered important when studying sarcopenic obesity [[6]].4. Etiology of Sarcopenic Obesity4.1. Age-Related Changes in Body Composition4.1.1. Skeletal Muscle
obesity 9701 an increase in the visceral fat mass [[30],[31]], which is highly associated with the development of obesity [[32]]. Increased visceral fat is an important risk factor for many health conditions, such as type
obesity 10007 a decreased quality of life and premature mortality [[33]].It was estimated that the prevalence of obesity in Europe in adults, aged 60 years or older, ranged from 20 to 30 percent in 2015 [[34]]. Obesity is
obesity 10304 intake and low levels of physical activity could, therefore, largely contribute to the development of obesity [[35]]. However, the reduction in the oxidative capacity as a result of the loss of skeletal muscle
obesity 10842 resistance, are commonly seen with age and could, via different mechanisms, contribute to the development of obesity [[37]]4.2. Causes and Consequences of Sarcopenic ObesitySince older adults are at risk for both the
obesity 10980 Consequences of Sarcopenic ObesitySince older adults are at risk for both the development of sarcopenia and obesity , a double burden exists. This is a condition that is defined as sarcopenic obesity [[38]]. Since, by
obesity 11063 of sarcopenia and obesity, a double burden exists. This is a condition that is defined as sarcopenic obesity [[38]]. Since, by definition, sarcopenic obesity is a combination of two conditions, the consequences
obesity 11112 This is a condition that is defined as sarcopenic obesity [[38]]. Since, by definition, sarcopenic obesity is a combination of two conditions, the consequences of sarcopenic obesity largely overlap with both
obesity 11187 by definition, sarcopenic obesity is a combination of two conditions, the consequences of sarcopenic obesity largely overlap with both sarcopenic and obesity. A few, but not all, of the consequences include an
obesity 11236 of two conditions, the consequences of sarcopenic obesity largely overlap with both sarcopenic and obesity . A few, but not all, of the consequences include an increased risk for physical limitations, hypertension,
obesity 11684 muscle mass [[40]]. This could be explained by the risk factors for the development of sarcopenia and obesity , as they are often similar [[8],[40]]. This makes it not very surprising that the two conditions often
obesity 11858 surprising that the two conditions often coexist. Additionally, it is often thought that sarcopenia and obesity work in a synergistic manner, as the consequences of sarcopenic obesity are often more severe than for
obesity 11930 thought that sarcopenia and obesity work in a synergistic manner, as the consequences of sarcopenic obesity are often more severe than for sarcopenia or obesity alone [[6],[7]].An important risk factor for both
obesity 11983 synergistic manner, as the consequences of sarcopenic obesity are often more severe than for sarcopenia or obesity alone [[6],[7]].An important risk factor for both sarcopenia and obesity is the lower rate of energy
obesity 12056 severe than for sarcopenia or obesity alone [[6],[7]].An important risk factor for both sarcopenia and obesity is the lower rate of energy expenditure with age, which is a result of lower physical activity, as well
obesity 12503 inflammation, and immunological factors, could contribute to the development of both sarcopenia and obesity [[42]]. Therefore, it is not very surprising that the two conditions often coexist.Not only do sarcopenia
obesity 12621 Therefore, it is not very surprising that the two conditions often coexist.Not only do sarcopenia and obesity have similar pathological causes, but the physiological consequences of obesity are also risk factors
obesity 12701 only do sarcopenia and obesity have similar pathological causes, but the physiological consequences of obesity are also risk factors for the development of sarcopenia [[43]]. To illustrate this, obesity may cause
obesity 12793 consequences of obesity are also risk factors for the development of sarcopenia [[43]]. To illustrate this, obesity may cause the resistance to anabolic stimuli, such as, growth factors, hormones, amino acids, and exercise,
obesity 13366 are metabolic reasons for the anabolic resistance in the muscle of older subjects [[49]].In addition, obesity is responsible for causing systemic low-grade inflammation, particularly by visceral fat, which excretes
obesity 14013 synthesis. However, the activation of proteolysis is mostly stimulated by inflammation [[54]]. Finally, the obesity -induced muscular fat infiltration does not only accelerate the anabolic resistance in obese older adults,
obesity 14532 in the muscle quality [[56]]. In summary, there are multiple causes and consequences for sarcopenic obesity , which are interrelated (Figure 1). Although some causes and consequences are not completely elucidated,
obesity 14716 are not completely elucidated, effective nutritional and exercise strategies to counteract sarcopenic obesity are certainly needed.5. Exercise StrategiesExercise has been found to be an effective strategy for treating
obesity 15022 disease, diabetes, and several cancers [[57]]. In addition, exercise as a strategy to prevent or treat obesity , has often been proposed in the literature and it has been widely studied in human intervention studies
obesity 15389 adults [[59]].The potential mechanisms by which exercise can induce improvement in the sarcopenia and obesity parameters are multi-factorial. Firstly, exercise has an important role in regulating energy balance.
obesity 16743 exercise is an effective strategy to improve the body composition parameters in both sarcopenia and obesity , exercise, as a strategy to counteract sarcopenic obesity, is extensively discussed in the literature.
obesity 16801 composition parameters in both sarcopenia and obesity, exercise, as a strategy to counteract sarcopenic obesity , is extensively discussed in the literature. Below, the effect of the different types of exercise on
obesity 16925 discussed in the literature. Below, the effect of the different types of exercise on the sarcopenic obesity parameters will be discussed, namely, resistance, eccentric, aerobic, concurrent, and electro exercise.
obesity 18585 J/kg, 95%CI: −0.90–12), or power (−13 w/kg, 95%CI: −1.4–28) in older women with sarcopenic obesity , compared with the non-exercising control group. The relatively short duration of the intervention and
obesity 20157 showed that resistance exercise is an effective strategy to improve the body composition in sarcopenic obesity , and that it has the potential to improve physical performance.5.2. Eccentric ExerciseEccentric exercise
obesity 20916 that was done in a geriatric population (14 women and 14 men, mean age 80 years, without sarcopenic obesity ), compared a resistance exercise and a surplus exercise strategy. The patients were followed for 12
obesity 22829 intervention, and it is therefore also seen as an effective strategy to counteract the development of obesity [[88],[89]].The separate effects of aerobic exercise on the muscle aerobic capacity in sarcopenic older
obesity 23792 strategy.Although there is only limited evidence available on the effects on aerobic exercise on sarcopenic obesity , aerobic exercise seems like an effective tool for losing excess fat mass and improving muscle performance
obesity 24126 resistance exercise or a nutritional strategy, could potentially be more effective in targeting sarcopenic obesity .5.4. Concurrent ExerciseConcurrent exercise is the combination of both resistance exercise and aerobic
obesity 24380 aerobic exercise have potentially positive effects on several body composition parameters in sarcopenic obesity , and could improve the muscle function. Furthermore, in addition to this effect, the combination of
obesity 26816 available, these results illustrate the potential beneficial effect of concurrent exercise on sarcopenic obesity .5.5. Electro StimulationElectrostimulation has recently become a popular technic in order to simulate
obesity 28219 debated.6. Nutritional StrategiesNutrition is a key factor in the development of both sarcopenia and obesity . The mechanisms by which nutrition affects sarcopenia and obesity are, however, different. Sarcopenia
obesity 28285 development of both sarcopenia and obesity. The mechanisms by which nutrition affects sarcopenia and obesity are, however, different. Sarcopenia is associated with an inadequate nutritional intake, whereas obesity
obesity 28390 obesity are, however, different. Sarcopenia is associated with an inadequate nutritional intake, whereas obesity is a result of an excess consumption of energy, leading to an imbalance between the energy intake and
obesity 28575 between the energy intake and energy expenditure [[40]]. Designing nutritional strategies for sarcopenic obesity should target both an optimal nutrient intake, so as to increase skeletal muscle mass or prevent muscle
obesity 32413 mass in this population, so as to compensate for the anabolic resistance as is present in sarcopenic obesity , especially in periods of energy deficit.The type of protein and the amino acid composition are also
obesity 34495 stimulated the overall satiety, prevented excess food intake, and therefore potentially reduced the obesity risk [[130]]. Thus, merely focusing on the total amount of dietary protein may not be most optimal for
obesity 34645 total amount of dietary protein may not be most optimal for improving the parameters of sarcopenic obesity , as a more spread protein intake during the day may also be an important factor that augment the effect
obesity 35773 increase the skeletal muscle mass and function, by optimizing muscle protein synthesis in sarcopenic obesity , should therefore take these factors into account.6.3. MicronutrientsThe low intake and low status of
obesity 37233 especially at risk for micronutrient deficiencies [[108]]. Although causal evidence is lacking, the obesity related deficiencies in several micronutrients are also linked to a decline in muscle mass, strength,
obesity 37745 strategies that are discussed above are individually not effective in targeting all of the sarcopenic obesity parameters simultaneously. A hypocaloric diet induces fat mass loss, but this is accompanied with the
obesity 37993 protein intake, which promotes the muscle protein synthesis, but is not effective in addressing the obesity parameters. An optimal strategy should therefore combine different strategies in order to optimize its
obesity 38957 compared with a lower protein diet. Although this seems a promising result for the treatment of sarcopenic obesity , inconsistent results were found in the obese and physically limited older adults, where the effect
obesity 40115 combination of a hypocaloric high-protein diet seems to be effective in the prevention of sarcopenic obesity , this strategy does not seem to be effective for the treatment of sarcopenic obesity.7. Combined Nutrition
obesity 40200 of sarcopenic obesity, this strategy does not seem to be effective for the treatment of sarcopenic obesity .7. Combined Nutrition and Exercise StrategiesA one component strategy, whether it is an exercise or
obesity 40387 it is an exercise or a nutritional strategy, may not be the most effective in countering sarcopenic obesity . The combination of strategies, in order to target all of the aspects of sarcopenic obesity, seems to
obesity 40479 sarcopenic obesity. The combination of strategies, in order to target all of the aspects of sarcopenic obesity , seems to be the most appropriate. Different studies that have used a combination of strategies so as
obesity 40620 appropriate. Different studies that have used a combination of strategies so as to prevent or treat sarcopenic obesity will be discussed below.7.1. Hypocaloric Diet and ExerciseA hypocaloric diet in obese older adults is
obesity 40934 simultaneously stimulating the loss of fat mass, are therefore essential in the treatment of sarcopenic obesity . Adding exercise to a hypocaloric diet in sarcopenic obese older adults could potentially prevent the
obesity 41324 following exercise. A hypocaloric diet in combination with exercise, in order to counteract sarcopenic obesity , has therefore been largely discussed in the literature [[63],[107],[145],[146]].To illustrate this,
obesity 45780 absence of effects. However, based on the individual effects of protein intake and exercise on sarcopenic obesity parameters, it was expected that changes in the body composition would be found. Future studies should
obesity 45994 investigate the effect of a high protein diet combined with exercise in order to counteract sarcopenic obesity .7.3. Hypocaloric Diet, Protein Intake and ExerciseIn a randomized controlled trial, the effect of a
obesity 48576 ConclusionsTo date, many different effective strategies have been developed to counteract either sarcopenia or obesity . However, only a limited number of studies have focused on the combination of both of these conditions.
obesity 48840 muscle mass and decrease fat mass may be challenging for developing effective strategies. As sarcopenic obesity has a synergistic detrimental effect on the physical functioning and overall health, effective strategies
obesity 48981 effect on the physical functioning and overall health, effective strategies that counteract sarcopenic obesity are highly warranted. The present review aimed to summarize these effective strategies, however, combining
obesity 49339 a limitation of this review. Additionally, because different methods are used to define sarcopenic obesity , it is difficult to compare the effectiveness of studies. Nevertheless, this review shows that sarcopenic
obesity 49453 difficult to compare the effectiveness of studies. Nevertheless, this review shows that sarcopenic obesity is a highly multi-factorial condition, which requires a multi-targeted approach. This review provides
obesity 50031 spread throughout the day, has the highest potential in improving different parameters of sarcopenic obesity . However, further research is needed to better understand the optimal rate of weight loss, the type,
obesity 50460 Finally, as new interventional technics and bariatric surgery are spreading out for the treatment of obesity in adults, we may have to consider the long term impact of bariatric surgery on muscle preservation
obesity 50731 these aging patients in the future [[153]].Figure 1Pathophysiology and interventions in sarcopenic obesity . Black arrows indicate the pathophysiology of sarcopenic obesity. Red arrows indicate potential targets
obesity 50796 1Pathophysiology and interventions in sarcopenic obesity. Black arrows indicate the pathophysiology of sarcopenic obesity . Red arrows indicate potential targets of nutritional and exercise interventions to counteract sarcopenic
obesity 50910 arrows indicate potential targets of nutritional and exercise interventions to counteract sarcopenic obesity .nutrients-10-00605-t001_Table 1Table 1Exercise and nutrition strategies to improve body composition
obesity 51057 1Exercise and nutrition strategies to improve body composition and physical performance in sarcopenic obesity .N *Age (Mean)Sarcopenic Obesity DefinitionType of InterventionIntervention Effect **Exercise strategiesVasconcelos

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