AVL juni 2016...28-6-2016 Spierpunt Symposium AvL 16 juni 2016 Jaap Dronkers 5 Op den Kamp CM, et...

28-6-2016

Spierpunt Symposium AvL 16 juni 2016Jaap Dronkers 1

Functioneelherstelna eenoncologischebuikoperatieJaap Dronkers

Spierpunt / Symposium AVL 22 juni 2016Jaap Dronkers

FT

VPL

RL

DT



MEDICAL FUNCTIONAL


Major life event



28-6-2016


ProFyt


ProFyt


Lawrence VA, Hazuda HP, Cornell JE, Pederson T, Bradshaw PT, Mulrow CD, Page CP.Functional independence after major abdominal surgery in the elderly.J Am Coll Surg. 2004 Nov;199(5):762-72

Functional decline after surgery


“An ICU-stay takes only days, but the effectsare still felt a decade later.”

Functional decline IC

PhD-thesis T. Timmers (surgeon) 2011


This hospitalization-associated disability occurs inapproximately one-third of patients older than 70 years of ageand may be triggered even when the illness that necessitatedthe hospitalization is successfully treated.

Covinsky KE, Pierluissi E, Johnston CB.Hospitalization-associated disability :"She was probably able to ambulate,but I'm not sure".JAMA. 2011 Oct 26;306(16):1782-93.

Hospitalization-associated disability


Iatrogenic

Sourdet S, Lafont C, Rolland Y, Nourhashemi F, Andrieu S, Vellas B.Preventable Iatrogenic Disability in Elderly Patients During Hospitalization.J Am Med Dir Assoc. 2015 Aug 1;16(8):674-81

1 2

3Spierpunt / Symposium AVL 22 juni 2016

Jaap Dronkers

28-6-2016




atient

Age

P


Age

Disease

Patient


Spiermassaverlies

Baracos V, Kazemi-Bajestani SM.Clinical outcomes related to muscle mass in humans with cancer and catabolic illnesses .Int J Biochem Cell Biol. 2013 Oct;45(10):2302-8


Age

Surgical stressDisease

Inactivity

Treatment


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INACTIVITY

83 % of the measuredhospital stay was spent

lying in bed

Brown CJ, Redden DT, Flood KL, Allman RM.The underrecognized epidemic of low mobility duringhospitalization of older adults.J Am Geriatr Soc. 2009 Sep;57(9):1660-5.


S P I E R

3x


English KL, Paddon-Jones D.Protecting muscle mass and function in older adults during bed rest.Curr Opin Clin Nutr Metab Care. 2010 Jan;13(1):34-9. Review.


jong

oud

operatie


young

old

SURGICAL STRESS

operation

frail


Age Chemo

SurgeryDisease

Inactivity

Treatment


28-6-2016


Op den Kamp CM, et al. Early body weight loss during concurrent chemo-radiotherapy for non-small cell lung cancer. J CachexiaSarcopenia Muscle. 2014 Jun;5(2):127-37.


Age Chemo

SurgeryDisease

Inactivity

Treatment

NutritionSpierpunt / Symposium AVL 22 juni 2016

Jaap Dronkers

Anabolic resistancePhysicalactivity


… have demonstrated that 2 weeks of inactivity(muscle disuse via limb immobilization), or evensimply decreased physical activity (reduced stepcount), can also induce anabolic resistance toamino acid administration or protein ingestion …

Wall BT, Cermak NM, van Loon LJ.Dietary protein considerations to support active aging.Sports Med. 2014 Nov;44 Suppl 2:S185-94.Spierpunt / Symposium AVL 22 juni 2016

Jaap Dronkers


Loss of muscle mass

“We propose that there should be a clear conceptualdistinction between the traditional, insidious sarcopenicprocess and the accelerated episodic loss of muscle andfunctional capacity during a ‘catabolic crisis’”


28-6-2016


Loss of muscle mass

“We propose that there should be a clear conceptualdistinction between the traditional, insidious sarcopenicprocess and the accelerated episodic loss of muscle andfunctional capacity during a ‘catabolic crisis’”


Percentage of the maximal muscle function

30%100% 0 %80% 60%

Daily

functionin

g

Indicatie

Dronkers JJ, Preoperative physical fitness in older patients, 2013


100% 0 %45% 25%

Percentage of maximale functie

Dagelijk

sfu

nctionere

n

Indicatie



30%100% 0 %

Frailty

Dagelijk

sfu

nctionere

n

Percentage of maximale spierfunctie

Indicatie



Fukuse T, Satoda N, Hijiya K, Fujinaga T.Importance of a comprehensive geriatric assessment in prediction of complications following thoracicsurgery in elderly patients.Chest. 2005 Mar;127(3):886-91.

Dependence for the performance ofADLs and impaired cognitiveconditions are important predictors ofpostoperative complications

Preoperatieve functionele statusals voorspeller postoperatief verloop

function30%100%


DISCHARGE DESTINATION 10 % n=169

0 1 2 3 4 5 6 7

Muscle mass (HGS)

Respiratory function (RCE)

Respiratory function (MIP)

Lower leg function (CRT)

ADL (TUG)

Activity level (LAPAQ)

Cough

Smoking

COPD

Heart diseases

Diabetes

Metastatic cancer

Age (> 80)

B-value (p<0.05)Odds ratio (p<0.1)


28-6-2016


ADL / zelfredzaamheidSpierkracht

Power

Spiermassa



Pedersen BK.Muscle as a secretory organ.Compr Physiol. 2013 Jul;3(3):1337-62.

Pedersen BK.Muscle as a secretory organ.Compr Physiol. 2013 Jul;3(3):1337-62.


Fiuza-Luces C, Garatachea N, Berger NA, Lucia A.Exercise is the real polypill.Physiology (Bethesda). 2013 Sep;28(5):330-58.


Hippocrates (400 v Chr)

“Walking is man’s best medicine”

Exercise is medicine



28-6-2016


Spiermassa

ADL / zelfredzaamheid

Gezondheid/Preventie

SpierkrachtPower

Fysiekeactiviteit

Toxiciteit chemotherapie

Vermoeidheid


- Spiermassa

Interventie



Interventie


LICHAMELIJKE ACTIVITEIT


Spiermassa

ADLZelfredzaamheid

GezondheidPreventie

SpierkrachtPower

Fysiekeactiviteit

HEBBEN

GEBRUIKEN


28-6-2016


Spiermassa

ADLZelfredzaamheid

GezondheidPreventie

SpierkrachtPower

Fysiekeactiviteit

HEBBEN

GEBRUIKEN


WeerstandstrainingWeerstandstraining


Weerstandstraining

• Intensiteit

– High intensity/low volume vs low intensity/high volume(Montero-Fernandez N, et al. 2012; Atherton PJ, et al. 2012 )

• Ouderen versus jongeren (Cochrane Database Syst Rev. 2009)

• Neurogene effecten (Gabriel DA, et al. 2006)

• Power of kracht

• Doel: kracht of functie (de Vreede, et al. 2006)


Hoe veel moet je bewegen




28-6-2016


Barreto P d S BMJ 2015;350:bmj.h23 ©2015 by British Medical Journal Publishing GroupSpierpunt / Symposium AVL 22 juni 2016

Jaap Dronkers

Peter Schnohr, James H. O’Keefe, Jacob L. Marott, Peter Lange, Gorm B. JensenDose of Jogging and Long-Term MortalityJ Am Coll Cardiol. 2015 Jan 16;65(5) Spierpunt / Symposium AVL 22 juni 2016

Jaap Dronkers

15 juni 2016Spierpunt / Symposium AVL 22 juni 2016

Jaap Dronkers

DANKVOORUWAANDACHT

AVL juni 2016...28-6-2016 Spierpunt Symposium AvL 16 juni 2016 Jaap Dronkers 5 Op den Kamp CM, et...

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