臨牀透析 Vol.31 No.8(6)


特集名 CKDにおけるサルコペニア・フレイル対策
題名 サルコペニア・フレイルに対する運動・リハビリテーション
発刊年月 2015年 07月
著者 若林 秀隆 横浜市立大学附属市民総合医療センターリハビリテーション科
【 要旨 】 フレイル高齢者に多いサルコペニアと持久力低下の原因は,加齢,活動,栄養,疾患に分類できる.サルコペニア・フレイルへの対応はその原因によって異なり,リハビリテーション栄養の考え方が有用である.サルコペニアと持久力低下の原因によってレジスタンストレーニング,持久性トレーニングを行うべき場合と禁忌の場合がある.不要な安静や不適切な栄養管理による医原性サルコペニアの予防が重要である.誤嚥性肺炎の治癒後には,低栄養などが原因でサルコペニアの摂食嚥下障害を認めやすい.そのため,誤嚥性肺炎では嚥下関連筋のレジスタンストレーニングとともに,入院当日からの早期離床,早期経口摂取,適切な栄養管理が大切である.
Theme Approach for sarcopenia and frailty in chronic kidney disease
Title Exercise and rehabilitation for sarcopenia and frailty
Author Hidetaka Wakabayashi Department of Rehabilitation Medicine, Yokohama City University Medical Center
[ Summary ] Frail elderly patients often have both sarcopenia and declining physical endurance. The causes of sarcopenia and declining physical endurance can be attributed to age, reduced activity and nutrition, as well as diseases. Assessment of the multi-factorial causes of sarcopenia and declining physical endurance is important because rehabilitation nutrition differs depending on the particular etiology. The concept of rehabilitation nutrition as a combination of both rehabilitation and nutritional care management, as outlined in the general International Classification of Functioning, Disability and Health guidelines is used to evaluate nutritional status and to maximize functionality in sarcopenic patients and the frail elderly. Resistance training and endurance training are useful for treatment of age-related sarcopenia and declining physical endurance. In contrast, resistance training and endurance training are contraindicated in nutrition-related sarcopenia without adequate nutrition care management.
Sarcopenic dysphagia is characterized by the loss of swallowing muscle mass and functions associated with generalized loss of skeletal muscle mass and function. Therapy strategies for sarcopenic dysphagia include dysphagia rehabilitation, general treatment of sarcopenia, and nutritional improvement. Malnutrition contributes to the etiology of secondary sarcopenia and sarcopenic dysphagia. Therefore, nutrition care managemen to increase muscle mass and strength is indispensable for sarcopenic dysphagia rehabilitation, including resistance training of swallowing muscles, early mobilization and early monitoring of oral intake.
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