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Managing and Reversing Sarcopenic Obesity Through Exercise and Physical Activity

February 2024
ACSMʼs Health & Fitness Journal 28(2):63-67

February 2024
28(2):63-67

DOI:10.1249/FIT.0000000000000940

Authors:

Paul Sorace

Hackensack University Medical Center

Alexios Batrakoulis

University of Thessaly

Combined aerobic and resistance training is highly recommended for adults with SO. Aerobic training induces profound effects on body fat and mass loss and cardiorespiratory fitness. Resistance training leads to gains in lean body mass and musculoskeletal fitness. Such positive adaptations are critical for older adults with SO who commonly experience sarcopenia and obesity. Importantly, combined training should be a progressive approach taking into account a client's needs, prior- ities, and responses to each training modality separately. In addition, combined training induces positive alterations in various cardiometabolic health-related markers among adults with obesity. Moderate-intensity aerobic exercise (40%–59% of heart rate reserve) with a weekly volume ranging from 3.5 to 5 hours divided into no less than 5 days of the week should be performed. High-intensity interval training also may be an adjunct and popular exercise solution that can be used with caution among individuals with metabolic health impairments and low physical fitness levels, but no exercise prescription guidelines exist focusing on the implementation of this particular training modality for people living with SO. For muscular fitness improvements, 8 to 10 muscle-strengthening exercises focusing on all the major muscle groups should be applied through full-body sessions, using 1 to 2 sets and gradually progressing to 3 to 4 sets of 6 to 15 repetitions at 60% to 85% of predicted 1-RM with 1.5 minutes of rest between sets. In terms of the progression, exercise volume should not be increased by more than 10% per week in both aerobic and resistance training, aiming to promote safe, feasible, and effective exercise experiences. Lastly, flexibility training also should be applied in conjunction with combined training as a separate component of an integrated exercise session on most days of the week, targeting muscle stiffness and impaired mobility commonly observed among older populations with obesity.

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Managing and Reversing Sarcopenic

Obesity Through Exercise and

Physical Activity

by Paul Sorace, M.S., FACSM, ACSM-CEP, CSCS; Alexios Batrakoulis, Ph.D., FACSM, ACSM-EP, ACSM-CPT, EIM, CSCS;

and Tom LaFontaine, Ph.D., FACSM, ACSM-CEP,CSCS

OVERVIEW OF SARCOPENIC OBESITY

Sarcopenic obesity (SO) is a classification of obesity in which low

skeletal muscle mass and muscle function are combined with el-

evated levels of adipose tissue (1). Evidence indicates that older

adults with SO may have higher levels of cardiovascular disease

risk factors, an increased risk of mortality, morbidity, disability,

and an impaired quality of life (2). Sarcopenic obesity is essen-

tially caused by an excess in energy intake and low levels of phys-

ical activity (3). Other contributing factors may include insulin

resistance and various hormonal changes (e.g.,increasedlevels

of cortisol). The most effective lifestyle treatment for SO is an ap-

proach that includes both weight loss, including dietary changes,

and a regular exercise program that includes both aerobic exer-

cise and progressive resistance training. Although there is evi-

dence that weight loss and exercise independently can result in

the prevention or reversal of SO and frailty, an intervention in-

corporating both weight loss and exercise has been shown to be

most effective for managing and/or reversing this disorder (1,4).

EPIDEMIOLOGY AND PATHOPHYSIOLOGY

SO is characterized by the coexistence of obesity (body mass

index [BMI] >30) and sarcopenia (loss of muscle strength,

function, and mass beyond that expected with aging) (5,6).

The term SO was first coined by Baumgartner et al. (7). With

aging, loss of skeletal muscle mass occurs and is commonly ac-

companied by a gain in fat mass (8). After age 50 years, muscle

mass declines 1% to 2% per year (9). Several factors contribute

to this disorder, some of which are listed in Table 1.

Persons with SO have increased morbidity and mortality

compared with obese persons without sarcopenia (5). Persons

with SO have an increased risk for cardiovascular disease,

diabetes, hypertension, disability, reduced bone mass, and

other chronic disorders compared with persons with obesity

or sarcopenia alone (5). Sarcopenic obesity is correlated with

multiple adverse cardiometabolic disorders, risk for falls,

frailty, and disability (5). The Figure illustrates the conse-

quences of and interplay between several factors and the de-

velopmentofSO(6).

Sarcopenic obesity affects 1 in 10 adults aged older than

60 years and 1 in 4 aged older than 80 years (6). However, sar-

copenia can occur in persons with obesity who are aged younger

than 60 years (5). In one study, the mean age of the population

was younger than 65 (10). In a study of 727 participants with

obesity, the mean age was 45.7 years and mean BMI was 37.6

MEDICAL REPORT

Associate Editor: Paul Sorace, M.S., FACSM, ACSM-CEP, CSCS

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in men and 37.8 in women (11). The prevalence of SO was

34.8% in men and 50.1% in women (11).

PHYSICAL ACTIVITY AND EXERCISE EFFECTS

The lifestyle interventions to prevent, slow, or possibly reverse

the progression of SO include exercise and physical activity

along with proper nutrition (12). Exercise and physical activity

may not completely prevent or reverse SO and its deleterious ef-

fects. However, it can delay the development and progression of

this condition (12,13).Some of the significant potential exercise/

physical activity benefits for individuals with SO, which are

common exercise/physical activity benefits, include:

•Increased muscle and bone mass

•Decreased adipose tissue, including abdominal adipose

tissue

•Increased insulin sensitivity

•Decreased inflammation

•Improved muscle function

•Enhanced ability to perform activities of daily living

•Decreased cardiometabolic disease risk factors

•Possible decreased overall morbidity and mortality

•Increased metabolic rate

•Positive hormonal changes (e.g., increased leptin sensitiv-

ity, increased levels of adiponectin, and apelin)

(1,12,14,15).

An increase in leptin sensitivity helps regulate body weight,

leads to lower triglycerides, and can stimulate muscle strength

and function (14). Exercise-induced increases in adiponectin

TABLE 1: Factors That Contribute to Sarcopenic Obesity

Adipose tissue-dependent metabolic derangements

Oxidative stress

Inflammation

Insulin resistance

Chronic diseases such as diabetes, hypertension, abnormal lipids,

cardiovascular disease

Poor dietary habits, particularly the Western diet, which is high in fat,

sugar, and salt and lacking in fiber

Sedentary lifestyle and lack of regular exercise

Low protein intake, weight cycling

Adapted from Donini LM, Busetto L, Bischoff SC, et al. Definition and diagnostic criteria

for sarcopenic obesity: ESPEN and EASO consensus statement. Obes Facts. 2022; 15(3):

321–35. Used with permission.

TABLE 2: Aerobic Training Recommendations for

Individuals with SO

Training Parameter Recommendation

Frequency ≥5 days/week

Intensity 40%–59% HRR, RPE 10–12;

progress to 60%–75% HRR, RPE 13–15

Time 30–60 minutes

Type Walking, cycling, and swimming.

HRR, heart rate reserve; RPE, rating of perceived exertion on a 6–20 scale.

Reprinted from: American College of Sports Medicine. ACSM's Guidelines forExercise

Testing and Prescription, 11th ed. Philadelphia (PA): Wolters Kluwer, 2021. Used with

permission.

Figure. The interaction among aging, obesity, and sarcopenia. Reprinted from Wannamethee SG, Atkins JL. Sarcopenic

obesity and cardiometabolic health and mortality in older adults: a growing health concern in an ageing population.

Curr Diab Rep. 2023;23:307–14. Used with permission.

MEDICAL REPORT

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and apelin in SO can increase muscle hypertrophy, decrease in-

flammation, and increase fat oxidation (15). It is important to

note that structured exercise and daily physical activity are both

important in the management of SO. For example, do a struc-

tured exercise session for an hour in the morning then be phys-

ically active during the day (e.g., walk the dog, take the stairs

rather than the escalator).

EXERCISE TESTING

Medical clearance is recommended for individuals with SO be-

fore participating in maximal exercise testing procedures or

high-intensity exercise schemes, regardless of signs or symptoms

of disease (16) (Table 2). Considering that musculoskeletal disor-

ders, cardiometabolic complications, physical function limita-

tions, extreme muscle weakness, fatigue, and poor durability

are common among people with SO, exercise testing should

be individualized to match the client's physiological profile (17,18).

Aerobic exercise testing should take into account the fact that

people with SO present with impaired cardiorespiratory and

musculoskeletal fitness and therefore, progressive treadmill exer-

cise testing seems to be a suitable approach. However, a de-

manding walking speed that exceeds 3.0 mph may not be a fea-

sible optionfor individuals withSO who demonstrate severe gait

limitations. Hence, a standard 6-minute walk test seems to be

the optimal submaximal exercise test for assessing aerobic ca-

pacity in these populations (16) (Table 3). It is worth mentioning

that persons with obesity tend to demonstrate a muscular system

that is prone to fatigue to a greater extent compared with those

with healthy weight (19). Thus, aerobic exercise testing protocols

should last no more than 10 minutes, aiming to avoid potential

muscular fatigue commonly observed in various populations (20).

Given that individuals with SO are characterized by poor

muscular fitness (21), resistance exercise testing should be mod-

ified to accommodate this population safely and appropriately.

In particular, all major muscle groups should be tested for

strength and endurance using feasible muscular fitness tests

and taking into consideration that most individuals with SO

have limited experience with resistance training (Table 4).

Therefore, stationary machines are mostly preferred rather than

free weights to facilitate the testing procedures and decrease

potential risk of injury. The most recommended assessment

method is a multiple-repetition maximum test, aiming to estimate

both muscular strength (one repetition maximum [1-RM]) and

endurance (number of repetitions completed) using a predetermined

TABLE 3: Resistance Training Recommendations for Individuals with SO

Training Parameter Recommendation

Frequency 2–3 nonconsecutive days/week

Intensity 60%–70% 1-RM, OMNI-RES 5–6;

progress to 71%–85% 1-RM, OMNI-RES 7–8

Time 1–2setsof12–15 repetitions, 1- to 2-minute rest between sets; progress to 3–4setsof6–10,

2- to 3-minute rest between sets.

Type 8 –10 exercises (full-body routine) using bodyweight movements, resistance bands, suspension exercise device, manual resistance,

stationary resistance machines, and free weights.

OMNI-RES, OMNI-resistance exercise scale of perceived exertion on a 0–10 scale.

Reprinted from: American College of Sports Medicine. ACSM's Guidelines for Exercise Testing and Prescription, 11th ed. Philadelphia (PA): Wolters Kluwer, 2021. Used with

permission.

Volume 28 | Number 2 www.acsm-healthfitness.org 65

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resistance until volitional fatigue (22). Handgrip strength also

can be used as a simple and reliable measurement of overall

muscular strength. More importantly, it is one of the diagnostic

criteria of sarcopenia, demonstrating an association with bone

health and osteoporotic fractures (23).

The timed up-and-go test should be used to evaluate func-

tional performance among older adults with SO who have high

risk of falls and difficulties with activities of daily living due to

poor musculoskeletal fitness levels that significantly affect physi-

cal function (24). In addition, the 30-second sit-to-stand test

could be a suitable option for testing muscular strength and en-

durance in lower extremities among older adults as part of a

functional fitness test battery. In general, exercise testing and fit-

ness assessment seem to be critical components of a personalized

exercise approach, allowing the exercise professional to tailor

the exercise program to meet each individual's specific condition

and associated needs.

EXERCISE PROGRAMMING

Combined aerobic and resistance training is highly recom-

mended for adults with SO. Aerobic training induces profound

effects on body fat and mass loss and cardiorespiratory fitness

(19). Resistance training leads to gains in lean body mass and

musculoskeletal fitness (25). Such positive adaptations are criti-

cal for older adults with SO who commonly experience sarcope-

nia and obesity. Importantly, combined training should be a

progressive approach taking into account a client's needs, prior-

ities, and responses to each training modality separately. In ad-

dition, combined training induces positive alterations in various

cardiometabolic health-related markers among adults with obe-

sity (26). Moderate-intensity aerobic exercise (40%–59% of

heart rate reserve) with a weekly volume ranging from 3.5 to

5 hours divided into no less than 5 days of the week should be

performed (27). High-intensity interval training also may be an

adjunct and popular exercise solution that can be used with cau-

tion among individuals with metabolic health impairments and

low physical fitness levels (28,29), but no exercise prescription

guidelines exist focusing on the implementation of this particular

training modality for people living with SO. For muscular fitness

improvements, 8 to 10 muscle-strengthening exercises focusing

on all the major muscle groups should be applied through

full-body sessions, using 1 to 2 sets and gradually progressing

to 3 to 4 sets of 6 to 15 repetitions at 60% to 85% of predicted

1-RM with 1.5 minutes of rest between sets. In terms of the pro-

gression, exercise volume should not be increased by more than

10% per week in both aerobic and resistance training, aiming to

promote safe, feasible, and effective exercise experiences. (27).

Lastly, flexibility training also should be applied in conjunction

with combined training as a separate component of an inte-

grated exercise session on most days of the week, targeting mus-

cle stiffness and impaired mobility commonly observed among

older populations with obesity (30).

1. Bouchonville MF, Villareal DT. Sarcopenic obesity: how do we treat it? Curr Opin

Endocrinol Diabetes Obes. 2013;20(5):412–9.

2. Stenholm S, Alley D, Bandinelli S, et al. The effect of obesity combined with low

muscle strength on decline in mobility in older persons: results from the

InCHIANTI study. Int. J. Obes. (Lond). 2009;33:635–44.

3. Milanovic Z, Pantelic S, Trajkovic N, Sporis G, Kostic R, James N. Age-related

decrease in physical activity and functional fitness among elderly men and

women. Clin Interv Aging. 2013;8:549–56.

4. Villareal DT, Chode S, Parimi N, et al. Weight loss, exercise, or both and physical

function in obese older adults. N Engl J Med. 2011;364:1218–29.

5. Donini LM, Busetto L, Bischoff SC, et al. Definition and diagnostic criteria for

sarcopenic obesity: ESPEN and EASO consensus statement. Obes Facts. 2022;

15(3):321–35.

6. Wannamethee SG, Atkins JL. Sarcopenic obesity and cardiometabolic health and

mortality in older adults: a growing health concern in an ageing population. Curr

Diab Rep. 2023;23:307–14.

7. Baumgartner RN. Body composition in healthy aging. Ann N Y Acad Sci.2000;

904:437–48.

8. Batsis JA, Villareal DT. Sarcopenic obesity in older adults: etiology, epidemiology

and treatment strategies. Nat Rev Endocrinol. 2018;14:513–37.

9. Mitchell WK, Williams J, Atherton P, Larvin M, Lund J, Narici M. Sarcopenia,

dynapenia, and the impact of advancing age on human skeletal muscle size and

strength; a quantitative review. Front P hysiol. 2012; 3:260.

10. Hong SH, Choi KM. Sarcopenic obesity, insulin resistance and their implications

in cardiovascular and metabolic consequences. Int J Mol Sci. 2020;21:494.

11. Poggiogalle E, Lubrano C, Sergi G, et al. Sarcopenic obe sity and metabolic

syndrome in adult Caucasian subjects. JNutrHealthAging. 2016;20(9):958–63.

12. Bilski J, Pierzchalski P, Szczepanik M, Bonior J, Zoladz JA. Multifactorial

mechanism of sarcopenia and sarcopenic obesity. Role of physical exercise,

microbiota and myokines. Cells. 2022;11(1):160.

13. Schoufour JD, Tieland M, Barazzoni R, et al. The relevance of diet, physical

activity, exercise, and persuasive technology in the prevention and treatment of

sarcopenic obesity in older adults. Front Nutr. 2021;8:661449.

14. Kalinkovich A, Livshits G. Sarcopenic obesity or obese sarcopenia: a cross talk

between age-associated adipose tissue and skeletal muscle inflammation as a

main mechanism of the pathogenesis. Ageing Res Rev. 2017;35:200–21.

15. Alizadeh Pahlavani H. Exercise therapy for people with sarcopenic obesity:

myokines and adipokines as effective actors.Fr ont Endocri nol (Lausan ne). 2022;

13:811751.

TABLE 4: Flexibility Training Recommendations for Individuals with SO

Training Parameter Recommendation

Frequency 2–3days/week

Intensity Stretch to the point of feeling tightness or slight discomfort.

Time 10- to 30-second hold for static stretching; 2–4 repetitions of each exercise at first, then progressing up to 30- to 60-second hold.

Type Static, dynamic, and/or proprioceptive neuromuscular facilitation stretching for all the major muscle groups.

Reprinted from: American College of Sports Medicine. ACSM's Guidelines for Exercise Testing and Prescription, 11th ed. Philadelphia (PA): Wolters Kluwer, 2021. Used with

permission.

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66 ACSM’sHealth & Fitness Journal

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16. American College of Sports Medicine. ACSM's Guidelines for Exercise Testing and

Prescription. 11th ed. Philadelphia (PA): Wolters Kluwer; 2021.

17. Dufour AB, Hannan MT, Murabito JM, et al. Sarcopenia definitions considering

body size and fat mass are associated with mobility limitations: the Framingham

study. J Gerontol A Biol Sci Med Sci. 2013;68:168–74.

18. Stenholm S, Harris TB, Rantanen T, et al. Sarcopenic obesity: definition, cause

and consequences. Curr Opin Clin Nutr Metab Care. 2008;11:693–700.

19. Lauretani F, Russo CR, Bandinelli S, et al. Age-associated changes in skeletal

muscles and their effect on mobility: an operational diagnosis of sarcopenia.

J Appl Physiol (1985). 2003;95:1851–60.

20. Yoon BK, Kravitz L, Robergs R. VO2max, protocol duration, and the VO2 plateau.

Med Sci Sports Exerc. 2007;39:1186–92.

21. Maffiuletti NA, Jubeau M, Munzinger U, et al. Differences in quadriceps muscle strength

and fatigue between lean and obese subjects. Eur J Appl Physiol. 2007;101:51–9.

22. National Strength and Conditioning Association. Essentials of Strength Training

and Conditioning. 4th ed. Champaign (IL): Human Kinetics; 2016.

23. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus

on definition and d iagnosis. Age Ageing. 2019;48(1):16–31.

24. Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in

community-dwelling older adults using the Timed Up & Go Test. Phys Ther.2000;

80:896–903.

25. Charette SL, McEvoy L, Pyka G,et al. Muscle hypertrophy response to resistance

training in older women. JApplPhysiol. (1985). 1991;70:1912–6.

26. Batrakoulis A, Jamurtas AZ, Metsios GS, et al. Comparative efficacy of 5 exercise

types on cardiometabolic health in overweight and obese adults: a systematic

review and network meta-analysis of 81 randomized controlled trials. Circ

Cardiovasc Qual Outcomes. 2022;15:e008243.

27. Donnelly JE, Blair SN, Jakicic JM, et al. American College of Sports Medicine

Position Stand. Appropriate physical activity intervention strategies for weight loss

and prevention of weight regain for adults. Med Sci Sports Exerc. 2009;41:459–71.

28. Batrakoulis A, Jamurtas AZ, Fatouros IG. High-intensity inter val training in metabolic

diseases: physiological adaptations. ACSMs Health Fit J. 2021;25:54–9.

29. Kercher VM, Kercher K, Levy P,et al. 2023 fitness trends from around the globe.

ACSMs Health Fit J. 2023;27:19–30.

30. Jeong Y, Heo S, Lee G, et al. Pre-obesity and obesity impacts on passive joint

range of motion. Ergonomics. 2018;61:1223–31.

Disclosure: The authors declare no conflict of interest and do

not have any financial disclosures.

Paul Sorace, M.S., FACSM, ACSM-CEP,

CSCS, is a clinical exercise physiologist in

New Jersey. He is an associate editor for

ACSM's Health & Fitness Journal

and the clinical associate editor for ACSM's

Certification Review, 4th and 5th edi-

tions. Paul also has served on numerous ACSM

committees.

Alexios Batrakoulis, Ph.D., FACSM, ACSM-EP,

ACSM-CPT, EIM, CSCS, is an adjunct pro-

fessor in the School of Physical Education,

Sport Science and Dietetics at the University

of Thessaly in Trikala, Greece, and the foun-

der of the International Obesity Exercise

Training Institute. Dr. Batrakoulis is the

chair of ACSM's CCRB-International Sub-

committee and has served on numerous ACSM and NSCA com-

mittees. He also was named the 2018 IDEA Personal Trainer

of the Year, 2019 IDEA China Fitness Innovator, 2020

NSCA Personal Trainer of the Year, 2021 PFP Trainer of

the Year, and 2022 ACSM Certified Professional of the Year.

Tom LaFontaine, Ph.D., FACSM, ACSM-CEP,

CSCS, has been a member of ACSM since

1975 and is currently a fellow emeritus mem-

ber. He is coauthor of The Exercise Pro-

fessional's Guide to Optimizing Health:

Strategies for Preventing and Reducing

Chronic Disease, a textbook published in co-

operation with ACSM, and has authored sev-

eral articles published in ACSM journals. He also has served on

several ACSM committees.

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ResearchGate has not been able to resolve any citations for this publication.

Sarcopenic Obesity and Cardiometabolic Health and Mortality in Older Adults: a Growing Health Concern in an Ageing Population

Article

Full-text available

Aug 2023
Curr Diabetes Rep

Purpose of Review Sarcopenic obesity (SO) is a growing public health problem in older adults. Whether SO confers higher risk of cardiometabolic disease and mortality than obesity or sarcopenia alone is still a matter of debate. We focus on recent findings on SO and cardiometabolic health and mortality in older adults. Recent Findings SO is associated with increased mortality compared to non-sarcopenic obesity, but similar mortality risk compared to sarcopenia without obesity. SO is associated with a higher risk of cardiovascular disease (CVD), diabetes, and physical disability than obesity or sarcopenia alone. SO, in the presence of diabetes, is associated with the highest risk of CVD and chronic kidney disease. A definition and diagnostic criteria for SO has recently been proposed (ESPEN and EASO). Summary SO is associated with more adverse outcomes overall than sarcopenia or obesity alone. Future research is required to assess the impact of the new SO definition on health outcomes.

2023 Fitness Trends from Around the Globe

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Apply It! From this article, the reader should be able to: • Identify top 20 fitness trends for Australia, Brazil, Europe, Mexico, Portugal, Spain, and the United States. • Recognize individual and unique fitness trends represented within the seven aforementioned regions. • Identify top five trends for each region during the last 3 years.

Comparative Efficacy of 5 Exercise Types on Cardiometabolic Health in Overweight and Obese Adults: A Systematic Review and Network Meta-Analysis of 81 Randomized Controlled Trials

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Full-text available

Apr 2022

Background: Although regular exercise is recommended for preventing and treating overweight/obesity, the most effective exercise type for improving cardiometabolic health in individuals with overweight/obesity remains largely undecided. This network meta-analysis aimed to evaluate and rank the comparative efficacy of 5 exercise modalities on cardiometabolic health measures in individuals with overweight/obesity. Methods: A database search was conducted in MEDLINE, Embase, Scopus, and Web of Science from inception up to September 2020. The review focused on randomized controlled trials involving exercise interventions consisting of continuous endurance training, interval training, resistance training, combined aerobic and resistance training (combined training), and hybrid-type training. Exercise interventions aimed to improve somatometric variables, body composition, lipid metabolism, glucose control, blood pressure, cardiorespiratory fitness, and muscular strength. The Cochrane risk of bias tool was used to evaluate eligible studies. A random-effects network meta-analysis was performed within a frequentist framework. The intervention ranking was carried out using a Bayesian model where mean and SD were equal to the respective frequentist estimates. Results: A total of 4331 participants (59% female; mean age: 38.7±12.3 years) from 81 studies were included. Combined training was the most effective modality and hybrid-type training the second most effective in improving cardiometabolic health-related outcomes in these populations suggesting a higher efficacy for multicomponent exercise interventions compared to single-component modalities, that is, continuous endurance training, interval training, and resistance training. A subgroup analysis revealed that the effects from different exercise types were mediated by gender. Conclusions: These findings corroborate the latest guidelines on exercise for individuals with overweight/obesity highlighting the importance of a multicomponent exercise approach to improve cardiometabolic health. Physicians and healthcare professionals should consider prescribing multicomponent exercise interventions to adults with overweight/obesity to maximize clinical outcomes. Registration: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42020202647.

Definition and Diagnostic Criteria for Sarcopenic Obesity: ESPEN and EASO Consensus Statement

Article

Full-text available

Feb 2022
OBESITY FACTS

Introduction: Loss of skeletal muscle mass and function (sarcopenia) is common in individuals with obesity due to metabolic changes associated with a sedentary lifestyle, adipose tissue derangements, comorbidities (acute and chronic diseases) and during the ageing process. Co-existence of excess adiposity and low muscle mass/function is referred to as sarcopenic obesity (SO), a condition increasingly recognized for its clinical and functional features that negatively influence important patient-centred outcomes. Effective prevention and treatment strategies for SO are urgently needed, but efforts are hampered by the lack of a universally established SO definition and diagnostic criteria. Resulting inconsistencies in the literature also negatively affect the ability to define prevalence as well as clinical relevance of SO for negative health outcomes. Aims and methods: The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) launched an initiative to reach expert consensus on a definition and diagnostic criteria for SO. The jointly appointed international expert panel proposes that SO is defined as the co-existence of excess adiposity and low muscle mass/function. The diagnosis of SO should be considered in at-risk individuals who screen positive for a co-occurring elevated body mass index or waist circumference, and markers of low skeletal muscle mass and function (risk factors, clinical symptoms, or validated questionnaires). Diagnostic procedures should initially include assessment of skeletal muscle function, followed by assessment of body composition where presence of excess adiposity and low skeletal muscle mass or related body compartments confirm the diagnosis of SO. Individuals with SO should be further stratified into stage I in the absence of clinical complications or stage II if cases are associated with complications linked to altered body composition or skeletal muscle dysfunction. Conclusions: ESPEN and EASO, as well as the expert international panel, advocate that the proposed SO definition and diagnostic criteria be implemented into routine clinical practice. The panel also encourages prospective studies in addition to secondary analysis of existing data sets, to study the predictive value, treatment efficacy and clinical impact of this SO definition.

Exercise Therapy for People With Sarcopenic Obesity: Myokines and Adipokines as Effective Actors

Article

Full-text available

Feb 2022

Hamed Alizadeh Pahlavani

Sarcopenic obesity is defined as a multifactorial disease in aging with decreased body muscle, decreased muscle strength, decreased independence, increased fat mass, due to decreased physical activity, changes in adipokines and myokines, and decreased satellite cells. People with sarcopenic obesity cause harmful changes in myokines and adipokines. These changes are due to a decrease interleukin-10 (IL-10), interleukin-15 (IL-15), insulin-like growth factor hormone (IGF-1), irisin, leukemia inhibitory factor (LIF), fibroblast growth factor-21 (FGF-21), adiponectin, and apelin. While factors such as myostatin, leptin, interleukin-6 (IL-6), interleukin-8 (IL-8), and resistin increase. The consequences of these changes are an increase in inflammatory factors, increased degradation of muscle proteins, increased fat mass, and decreased muscle tissue, which exacerbates sarcopenia obesity. In contrast, exercise, especially strength training, reverses this process, which includes increasing muscle protein synthesis, increasing myogenesis, increasing mitochondrial biogenesis, increasing brown fat, reducing white fat, reducing inflammatory factors, and reducing muscle atrophy. Since some people with chronic diseases are not able to do high-intensity strength training, exercises with blood flow restriction (BFR) are newly recommended. Numerous studies have shown that low-intensity BFR training produces the same increase in hypertrophy and muscle strength such as high-intensity strength training. Therefore, it seems that exercise interventions with BFR can be an effective way to prevent the exacerbation of sarcopenia obesity. However, due to limited studies on adipokines and exercises with BFR in people with sarcopenic obesity, more research is needed.

Multifactorial Mechanism of Sarcopenia and Sarcopenic Obesity. Role of Physical Exercise, Microbiota and Myokines

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Full-text available

Jan 2022

Obesity and ageing place a tremendous strain on the global healthcare system. Age-related sarcopenia is characterized by decreased muscular strength, decreased muscle quantity, quality, and decreased functional performance. Sarcopenic obesity (SO) is a condition that combines sarcopenia and obesity and has a substantial influence on the older adults’ health. Because of the complicated pathophysiology, there are disagreements and challenges in identifying and diagnosing SO. Recently, it has become clear that dysbiosis may play a role in the onset and progression of sarcopenia and SO. Skeletal muscle secretes myokines during contraction, which play an important role in controlling muscle growth, function, and metabolic balance. Myokine dysfunction can cause and aggravate obesity, sarcopenia, and SO. The only ways to prevent and slow the progression of sarcopenia, particularly sarcopenic obesity, are physical activity and correct nutritional support. While exercise cannot completely prevent sarcopenia and age-related loss in muscular function, it can certainly delay development and slow down the rate of sarcopenia. The purpose of this review was to discuss potential pathways to muscle deterioration in obese individuals. We also want to present the current understanding of the role of various factors, including microbiota and myokines, in the process of sarcopenia and SO.

High-Intensity Interval Training in Metabolic Diseases: Physiological Adaptations

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Full-text available

Sep 2021

HIIT is an effective exercise mode inducing meaningful benefits on physical fitness, metabolic health, and cardiovascular function. This training approach requires adults with metabolic diseases to engage in physically and mentally demanding conditions with respect to the exercise intensity commonly used in other modalities. However, emerging research reveals that incorporating HIIT as part of a comprehensive exercise program for individuals with impaired metabolic health could be a pleasurable and feasible training option aimed at improving health and fitness.

The Relevance of Diet, Physical Activity, Exercise, and Persuasive Technology in the Prevention and Treatment of Sarcopenic Obesity in Older Adults

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Full-text available

May 2021

The aging population faces two conditions that threaten healthy aging: high fat mass (obesity) and low muscle mass and function (sarcopenia). The combination of both—referred to as sarcopenic obesity—synergistically increases the risk of adverse health outcomes. The two conditions often co-occur because they reinforce each other and share common etiologies, including poor nutrition and inactivity. All aging people are at risk of gaining weight and losing muscle mass and could benefit from improvements in physical activity, exercise and dietary intake. one specific window of opportunity is during the transient time of retirement, as older adults already need to restructure their daily activities. It is key to change lifestyle behavior in a sustainable manner, providing scientifically proven, personalized, and acceptable principles that can be integrated in daily life. Health technologies (e.g., applications) can provide promising tools to deliver personalized and appealing lifestyle interventions to a large group of people while keeping health care costs low. Several studies show that health technologies have a strong positive effect on physical activity, exercise and dietary intake. Specifically, health technology is increasingly applied to older people, although strong evidence for long term effects in changing lifestyle behavior is generally lacking. Concluding, technology could play an important role in the highly warranted prevention of sarcopenic obesity in older adults. Although health technology seems to be a promising tool to stimulate changes in physical activity, exercise and dietary intake, studies on long lasting effects and specifically targeted on older people around the time of retirement are warranted.

Sarcopenic Obesity, Insulin Resistance, and Their Implications in Cardiovascular and Metabolic Consequences

Article

Full-text available

Jan 2020
INT J MOL SCI

The prevalence of sarcopenic obesity is increasing worldwide, particularly amongst aging populations. Insulin resistance is the core mechanism of sarcopenic obesity and is also associated with variable cardiometabolic diseases such as cardiovascular disease, type 2 diabetes mellitus, and non-alcoholic fatty liver disease. Fat accumulation in muscle tissue promotes a proinflammatory cascade and oxidative stress, leading to mitochondrial dysfunction, impaired insulin signaling, and muscle atrophy. To compound the problem, decreased muscle mass aggravates insulin resistance. In addition, the crosstalk between myokines and adipokines leads to negative feedback, which in turn aggravates sarcopenic obesity and insulin resistance. In this review, we focus on the molecular mechanisms linking sarcopenic obesity and insulin resistance with various biological pathways. We also discuss the impact and mechanism of sarcopenic obesity and insulin resistance on cardiometabolic disease.

Definition and diagnostic criteria for sarcopenic obesity: ESPEN and EASO consensus statement

Article

Feb 2022
CLIN NUTR

Introduction Loss of skeletal muscle mass and function (sarcopenia) is common in individuals with obesity due to metabolic changes associated with a sedentary lifestyle, adipose tissue derangements, comorbidities (acute and chronic diseases), and during the ageing process. Co-existence of excess adiposity and low muscle mass/function is referred to as sarcopenic obesity (SO), a condition increasingly recognized for its clinical and functional features that negatively influence important patient-centred outcomes. Effective prevention and treatment strategies for SO are urgently needed, but efforts are hampered by the lack of an universally established SO Definition and diagnostic criteria. Resulting inconsistencies in the literature also negatively affect the ability to define prevalence as well as clinical relevance of SO for negative health outcomes. Aims and methods The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) launched an initiative to reach expert consensus on a Definition and diagnostic criteria for SO. The jointly appointed international expert panel proposes that SO is defined as the co-existence of excess adiposity and low muscle mass/function. The diagnosis of SO should be considered in at-risk individuals who screen positive for a co-occurring elevated body mass index or waist circumference, and markers of low skeletal muscle mass and function (risk factors, clinical symptoms, or validated questionnaires). Diagnostic procedures should initially include assessment of skeletal muscle function, followed by assessment of body composition where presence of excess adiposity and low skeletal muscle mass or related body compartments confirm the diagnosis of SO. Individuals with SO should be further stratified into Stage I in the absence of clinical complications, or Stage II if cases are associated with complications linked to altered body composition or skeletal muscle dysfunction. Conclusions ESPEN and EASO, as well as the expert international panel, advocate that the proposed SO Definition and diagnostic criteria be implemented into routine clinical practice. The panel also encourages prospective studies in addition to secondary analysis of existing datasets, to study the predictive value, treatment efficacy, and clinical impact of this SO definition.