Combined Exercise and Nutrition Intervention for Sarcopenia

Change from baseline 5-times chair stand test to 12 weeks after assessment, measured by 5-times chair stand test

Short Physical Performance Battery [range from 0 to 12 score] The scores range from 0 (worst performance) to 12 (best performance) with higher scores indicating better functionality. It is a group of measures that combines the results of the gait speed, chair stand and balance tests.

measured by 6 meter gait speed

measured using Dual-energy X-ray absorptiometry (DEXA)

Evaluation of quality of life using EQ-5D [range from 5 to 25 score]. Higher value means worse quality of life

Evaluation of basic and instrumental activities of daily living using Korean Activity of Daily Living (K-ADL), Korean Instrumental Activity of Daily Living (K-IADL) [range from 0 to 33]. Low value means poor ability of activities.

Evaluation of quality of life using Strength, Assistance with walking, Rising from a chair, Climbing stairs and Falls (SARC-F) questionnair [range from 0 to 10] This questionnaire is named after the first letters of the five survey questions: strength, assistance in walking, rising from a chair, climbing stairs, and falls.

The SARC-F questionnaire is a screening tool that can be rapidly implemented by clinicians to identify probable sarcopenic patients. The questionnaire screens patients for self-reported signs suggestive of sarcopenia, which include deficiencies in strength, walking, rising from a chair, climbing stairs, and experiencing falls. Each of the self-reported parameters receives a minimum and maximum score of 0 and 2, respectively, with the greatest maximum SARC-F score being 10 Grading method

• Calculate the total score of the five questions answered by the subject.
• Minimum 0 ~ Maximum 10 points
• If the score is 4 or higher, sarcopenia is suspected.

• Minimum nutritional assessment(MNA)

• Items: weight, weight (kg), exercise pad, nervous/mental problems, body mass index (kg/m2) Scoring: Add up a score between 0 and 3 for your answer to each question.
• Items: residence, medication use, bedsore treatment, number of meals per day Scoring: Add up a score between 0 and 2 for your answer to each question.
• Results

• Malnutrition indicator score Malnutrition: <17, Malnutrition Risk: 17-23.5 points, Normal: 24-30 points.
• Daily target protein(g/day)= g x body weight MNA 24-30 points (nutritious): 1.2 g/kg/day MNA 17-23.5 points (at risk): 1.5 g/kg/day MNA <17 points (malnutrition): 1.5 g/kg/day

2)Korean Protein Assessment Tool(KPAT) Check the average amount and frequency of meals and snacks consumed daily, weekly, and monthly through a questionnaire to determine the average amount of protein consumed per day(protein intake: g/day).

3)Nutrition counseling The protein deficiency(g/day) is calculated from the daily target protein intake (g/day) calculated from the MNA results and the daily protein intake(g/day) confirmed from the PIAT results. Nutritional counseling advises that insufficient protein intake be consumed through protein powder.

Evaluation of hand grip strength using Hand-held dynamometer

Evaluation of delirium using Delirium Rating Scale (DRS) [range from 0 to 32 score]. Higher value means worse delrious status

measured by Korean Physical Activity Scale for the Elderly (K-PASE) [range from 0 to 1382.52 score]. Higher value means better physical status

Evaluation of cognitive state using Korean Mini Mental Status Examination, 2nd edition (K-MMSE2) [range from 0 to 30 score] Evaluate the subject's cognitive function by answering a total of 30 questions in 6 areas and performing test sentences.

If the subject fails to provide an appropriate answer or fails to follow instructions, a score of 0 is given.

• 0~17 points : obvious cognitive impairment
• 18 to 23 points : Mild cognitive impairment
• 24~30 points : No cognitive impairment

Evaluation of psychiatric state using Short Form of Geriatric Depression Scale-Korea (SGDS-K) [range from 0 to 30 score]

• 0~4 points : normal
• 5~9 points : mild depression
• 10 points or more : severe depression

measured by Standardized Swallowing Assessment (SSA)

measured by Korean version of Health Empowerment Scale (K-HES) [range from 8 to 40 score]. Higher value means better empowerment status