Exercise as it relates to Disease/The effects of exercise habits on sarcopenia and its association with a lower prevalence within the elderly
This is a critical analysis on the Japanese article “Exercise habits during middle age are associated with lower prevalence of sarcopenia: the ROAD study”. .
What is the background to this research?
Sarcopenia is a disease associated with ageing. It is the gradual loss of muscle and strength within the elderly affecting balance, gait and overall ability to complete daily tasks/activities. Sarcopenia is caused by an imbalance between the signals of muscle growth and muscle tear down resulting in a degenerating muscle. The cell growth process is known as anabolism and cell tear down catabolism. During the ageing course the body becomes resistant to the growth signals moving the balance towards catabolism rather than anabolism resulting in muscle loss. Medical professionals generally diagnose sarcopenia based on the symptoms of individual reports. Dual energy X-ray absorptiometry (DXA) and physical tests can be used to actually determine whether an individual is suffering from sarcopenia or not. 
Where is the research from?
This is a Japanese study using elderly participants of Japanese population-based cohorts of the Research on Osteoarthritis/osteoporosis Against Disability (ROAD) study and sarcopenia definition according to the European Working Group on Sarcopenia in Older People (EWGSOP) . All authors have experience within the field of study with them working in the Department of Clinical Motor System Medicine, Department of Joint Disease Research, Department of Sensory and Motor System Medicine and the National Rehabilitation Center for Persons with Disabilities, Japan.  The research is relevant to Australia as sarcopenia is a disease that affects the elderly in in every country not just specific locations and exercise habits are important in day to day life for individuals.
What kind of research was this?
The research was a cohort study (prospective observational study). A clinical research study in which individuals have a certain condition present (sarcopenia) or receive treatment over time while being followed and compared with another group of individuals for are not affected by the condition. 
What did the research involve?
The research involved 1000 elderly Japanese participants (349 men and 651 women aged ≥65 years) suffering sarcopenia determined according to the EWGSOP definition. Participants completed an interviewer-administered questionnaire comprising 400 items regarding lifestyle information such as smoking habits, alcohol consumption, and physical activity (exercise history, walking habits, gait speed, chair stand test and one-legged stand test) and undertook anthropometric measurements including height, weight, body mass index (BMI) and assessments of handgrip strength, gait speed, and skeletal muscle mass measured by bioimpedance analysis. 
The methodology approach was the best approach as the study entitled Research on Osteoarthritis/osteoporosis Against Disability was conducted from 2005 where 3040 participants in 3 different areas of Japan were used. Over the years participants were surveyed and assessed, slowly narrowing down the numbers to 1000 for the Exercise habits during middle age are associated with lower prevalence of sarcopenia: the ROAD study in 2013 .
In terms of limitations the study faced, there were four main ones. Firstly, due to it being a type of observational study a causal relationship could not be determined. Secondly, exercise habits from the participants was self-reported creating a possibility of recall bias. Thirdly, due to certain requirements participants were excluded from the study suggesting the study doesn’t truly represent the general population. And fourthly, characteristics of the population (BMI and age) may affect the data collected, exploring a more varied population group would create better results. 
What were the basic results?
The results showed the participants with sarcopenia had a greater age and there body mass index (BMI), skeletal muscle mass index (SMI) and appendicular skeletal muscle mass (ASM) were significantly lower. Throughout the physical performance results show the chair stand was greater and the one leg stand time was lesser, grip strength and gait speed were also lesser for the individuals both men and women suffering from sarcopenia. Those who had exercise habits during middle age showed significantly less signs of sarcopenia then those who didn’t. 
The researches presented the quantitative data in tables, graphs and written interpretations showing the mean (SD) results of individuals comparing the difference between those affected by sarcopenia and not. The authors didn’t over-emphasise the results as they showed exercise habits made a significant difference during the middle age of participants.
What conclusions can we take from this research?
From the research the data shows there is a strong relationship with early exercise habits in middle age individuals and lower prevalence of sarcopenia. These exercise habits act as a protective factor against sarcopenia and is shown effective in maintaining muscle strength and physical performances such as grip strength and standing time. Though for further investigation, long-term longitudinal epidemiological studies are required to develop effective intervention programs. 
The findings in this study relate to many other studies suggesting exercise is a protective factor against sarcopenia. Roubenoff shows exercise is a marker for successful aging and has a positive relationship with sarcopenia.  Taaffe also shows in his article, individuals should incorporate exercise into their weekly schedule as it has a positive effect on sarcopenia and acts to reduce the chances of suffering from it. 
There are no implications from this study that will affect individuals in practical advice as the research suggests that individuals should incorporate exercise into their weekly routine, especially resistance training to maintain muscle mass and act as a protective factor against sarcopenia.  Individuals looking to incorporate exercise into their weekly schedule should seek help form exercise professionals to attain the best results. This will ensure the safety of individuals when performing exercise as they will have the correct know-how.
For further information on sarcopenia, please follow the links.
International Osteoporosis Foundation (IOF): https://www.iofbonehealth.org/what-sarcopenia
Society on Sarcopenia, Cachexia and Wasting Disorders: http://society-scwd.org/sarcopenia/
- .Akune, T., Muraki, S., Oka, H., Tanaka, S., Kawaguchi, H., Nakamura, K. and Yoshimura, N. (2013). Exercise habits during middle age are associated with lower prevalence of sarcopenia: the ROAD study. Osteoporosis International, 25(3), pp.1081-1088.
- iofbonehealth. (2018). What is Sarcopenia? [online] Available at: https://www.iofbonehealth.org/what-sarcopenia
- Healthline. (2018). How to Fight Sarcopenia (Muscle Loss Due to Aging). [online] Available at: https://www.healthline.com/nutrition/sarcopenia
- Alana Biggers, M. (2018). Sarcopenia: Causes, symptoms, and management. [online] Medical News Today. Available at: https://www.medicalnewstoday.com/articles/318501.php [Accessed 19 Sep. 2018].
- Research.library.gsu.edu. (2018). GSU Library Research Guides: Literature Reviews: Types of Clinical Study Designs. [online] Available at: http://research.library.gsu.edu/c.php?g=115595&p=755213
- Roubenof, R. (2018). Exercise, Sarcopenia, Cognition, and Mood. Nestl´e Nutrition Workshop Series Clinical & Performance Program, 6(1), pp.151–162.
- Taaffe, DR. Sarcopenia: exercise as a treatment strategy [online]. Australian Family Physician, Vol. 35, No. 3, 2006 Mar: 130-4. Available at: <https://search.informit.com.au/documentSummary;dn=364765713154678;res=IELHEA> ISSN: 0300-8495.