Age-associated changes in the body, depending on the presence and activity of various diseases, can proceed according to physiological or pathological types. Biological, physiological, and psychological aging processes and their impact on human life are determined by the domains of individual vitality. The following types of domains are distinguished:
This section will focus in detail on the motor domain, changes in which can lead to the development or exacerbation of chronic diseases, and in some cases, to traumatic events.
The state of the musculoskeletal system undoubtedly plays a leading role in forming the motor domain of individual vitality. Diseases of the musculoskeletal system are widespread worldwide and are one of the main causes of disability in developed countries. The last decades of the 20th century showed that bone and joint diseases are increasingly significant among diseases in people over 50, but risk factors and their first manifestations can be found at a younger age. Patients with comorbid pathology (cardiovascular, respiratory, neuroimmunoendocrine system diseases) often also complain about the musculoskeletal system, significantly increasing mortality in this group of patients.
This issue is so relevant for the 21st century that WHO proclaimed the first decade of the 21st century as the Bone and Joint Decade (2000–2010) and highlighted the most common musculoskeletal diseases in society. The most significant of these are osteoarthritis, osteoporosis, and sarcopenia.
Below we will provide general information about these conditions and the basic principles of their management. It will be specifically highlighted that nutraceutical support, including peptide drugs, is important for each disease, which will be elaborated in section 6.3.4.
OA is a chronic degenerative progressive joint disease characterized by pain syndrome and the development of marginal osteophytes with impaired functional activity, significantly reducing patients’ quality of life. According to the global burden of disease study 2019, OA affects 7% of the global population, over 500 million people, with the number of patients expected to increase due to longer life spans and the number of patients with excess body weight. The most significant risk factors for OA development are age, excess body weight, genetic predisposition, developmental anomalies of the musculoskeletal system (weakness of the lower limb muscles, joint hypermobility), constitutional factors (female gender, race), occupational factors (vibration), and decreased estrogen levels in postmenopausal women. A crucial role in the pathogenesis and progression of osteoarthritis is played by chronic microtrauma to the joint, degeneration and destruction of joint cartilage, accompanied by inflammation with the formation of synovitis with focal hypoxia and bone ischemia.
OA treatment is comprehensive and includes non-pharmacological and pharmacological methods, and in cases of significant radiological changes, surgical interventions may be required. In the early stages of OA development, non-pharmacological methods of influence are most significant: weight correction, educational programs on nutrition and lifestyle normalization, regular physical exercises, and the use of assistive devices (walking with a cane, “Nordic” walking, wearing supinators, orthoses). If necessary, symptomatic (NSAIDs, analgesics) and structure-modifying drugs (chondroitin sulfate, glucosamine sulfate, the combination of chondroitin sulfate and glucosamine) are used for pharmacological correction. The latter, being structural analogs of cartilage, stimulate the synthesis of proteoglycans by chondrocytes and inhibit catabolic processes in the cartilage. Drugs for parenteral use are also used – glycosaminoglycan-peptide complex (10-25 injections per course, treatment courses with an interval of 4-6 months), which also contributes to slowing the progression of the disease.
OP is a metabolic bone disease characterized by decreased bone mass, disruption of the microarchitecture of bone tissue, and, as a consequence, fractures with minimal trauma (falling from one’s height, awkward movement, coughing, sneezing). About 14 million people worldwide suffer from osteoporosis, and in Russia, among people aged 50 and older, OP is found in 34% of women and 27% of men. Typical fractures for this pathology are fractures of the proximal femur, radius, and vertebral bodies. At the same time, mortality rates within the first 6 months after a fracture are 5-20% higher compared to the same indicator in people of the same age without fractures.
The development of OP depends on genetic predisposition, lifestyle, insufficient physical activity, endocrinological status (estrogen deficiency, the state of phosphorus-calcium metabolism, the level of parathyroid hormone, vitamin D, growth hormone, calcitonin, thyroid hormones), the presence of concomitant diseases, the use of drugs (long courses of glucocorticosteroids), age-related changes (change in the expression of regulatory molecules of osteoblastogenesis and osteoclastogenesis).
Preventive pharmacological treatment of OP can be conditionally divided into antiresorptive, mainly suppressing bone resorption by acting on osteoclasts (bisphosphonates, denosumab), and anabolic drugs enhancing bone formation (teriparatide). The above-mentioned drugs are recommended to be combined with calcium and vitamin D supplements. Non-drug methods of weight correction, nutrition and lifestyle, the introduction of regular physical activity, are also a mandatory component of comprehensive therapy. Fractures require mandatory surgical treatment with subsequent early activation of the patient (on the 1-2nd day after surgery) and treatment of osteoporosis that led to bone integrity disruption.
Sarcopenia is a syndrome characterized by progressive loss of skeletal muscle mass and strength, accompanied by a high risk of adverse outcomes such as physical disability, low quality of life, and death. Loss of body muscle mass begins after the age of 30 and amounts to 0.1-0.5% per year, after 60 years the rate of decline can reach 8% per year, after 70 years – up to 15% per year (while the amount of subcutaneous fat tissue often only increases). In muscle tissue, there is a disruption in the processes of hyperplasia, i.e., the formation of new muscle fibers. Ligaments and tendons also undergo age-related changes due to changes in the structure of connective tissue, calcium salt deposition, and structural changes in protein synthesis. In the joints, the synovial membrane thins, hyalinization occurs, elements of connective tissue are included, the volume of synovial fluid decreases, dystrophic changes in joint cartilages develop, subchondral sclerosis, the formation of subchondral cysts, changes in the spatial relationships of bones, a decrease in the degree of congruence of joint surfaces. It is important that myogenic factors, contributing to the degeneration and atrophy of muscle fibers, reduce the muscle volume and body mass of the patient, thereby reducing the muscular frame of periarticular tissues, which forms joint hypomobility and increasing involutional changes in them. The developed sarcopenia triggers processes forming joint contractures, which, in turn, increase bone resorption and thinning processes, increasing osteoporotic changes. In turn, osteoporosis and osteoarthritis, both isolated and especially in combination, increase dystrophic changes in muscle fibers, stimulating the processes of sarcopenia development, thus forming a vicious circle initiating the target chain of senile asthenia (SA).
Along with the launch of internal factors, external factors also contribute to the progression of these processes. Firstly, environmental factors form a hypomobile environment; secondly, medical factors – past injuries, prolonged immobilization, etc. Nutritional factors (the phenomenon of rapid satiety, malabsorption syndrome, hyperleptinemia in sarcopenia) are of significant importance, as a result of which protein intake decreases, leading to a decrease in the supply of substances necessary for muscle support, such as creatine. As for malnutrition syndrome, its role as a direct predictor of osteoporosis and osteoarthritis lies in the fact that the decrease in calcium absorption in the intestine leads to a decrease in its content in bone tissue and, consequently, to an increase in bone porosity.
Both osteoarthritis and osteoporosis and sarcopenia cause the onset and progression of chronic pain syndrome. The main mechanism of pain development is nociceptive. The pain syndrome becomes a factor limiting patients’ activity and leading to the formation of “painful behavior”. The developed degenerative-dystrophic and atrophic changes in the musculoskeletal system often have an irreversible nature and can lead to fatal physical, psychological, and economic consequences. The magnitude of the problem is determined by unfavorable medical-social consequences – gait, balance, and strength disorders, impaired mobility function leading to an increased risk of subsequent falls and fractures, as well as social consequences – reduced life activity, increased dependence on outside help, increased overall disability rate.
Early identification of patients with early manifestations of osteoarthritis, osteoporosis, sarcopenia, and their risk factors increases the effectiveness of preventive and rehabilitation programs.
Understanding the importance of peptides in therapeutic and preventive programs for osteoarthritis, osteoporosis, and sarcopenia (section 6.3.) requires an appreciation of how crucial peptide regulation is in the activity of the musculoskeletal system from the perspective of modern physiological effects.
Peptides are chemical compounds whose molecules are constructed from residues of α-amino acids linked together by peptide bonds. Many compounds have a peptide nature: those with hormonal activity (insulin, glucagon, oxytocin, vasopressin); those regulating gastrointestinal tract processes (gastrin, gastric inhibitory peptide, hepatoprotective peptides); compounds with analgesic effects (opioid peptides); organic substances regulating higher nervous activity, arterial pressure, and vascular tone (angiotensin II, bradykinin, and others); antimicrobial peptides; immunomodulating peptides, and so on.
Given their diverse bioregulatory effects on the body, peptides are widely used in various medical fields, particularly their potential application concerning the musculoskeletal system is actively explored. Many peptides have been isolated from existing growth factors and proteins involved in bone tissue regeneration (e.g., RANKL-binding peptide, AC-100, mechano growth factor E and B2A2-K-NS). Peptides derived from food proteins have been studied for their significant impact on improving conditions in sarcopenia, promoting muscle protein synthesis, and inhibiting their degradation. Interestingly, the vasoactive intestinal peptide (VIP) can prevent chronic cartilage damage and joint remodeling that occurs in osteoarthritis. It has been suggested that downregulation of VIP leads to an increase in the production of pro-inflammatory cytokines, which may contribute to the development of OA.
A significant number of peptides have been developed and studied to enhance bone regeneration. For example, the parathyroid hormone peptide 1–34 (teriparatide) is one of the first artificially synthesized amino acid fragments approved for the prevention and treatment of osteoporosis. PTH 1-34 stimulates the proliferation, differentiation of osteoblasts, and prevents their apoptosis. Several clinical observations have shown that teriparatide can contribute to the healing of non-unions of the sternum, stress fractures, atrophic non-union of the humerus diaphysis, femoral non-union, hip fractures, delayed unions, periprosthetic fractures, sacral and pubic insufficiency fractures. In a prospective randomized double-blind study, Aspenberg et al. analyzed the effect of daily injections of 20 and 40 μg recombinant teriparatide compared to placebo in postmenopausal women with distal radial fractures. Data on faster bone healing in the experimental group were obtained (p = 0.006).
The protein related to parathyroid hormone (PTHrP) consists of 139–175 amino acids and is a key regulator of the growth, differentiation, and development of fetal skeleton cells. Endogenous PTHrP plays an important role in fracture healing, as demonstrated in a haplo-insufficiency PTHrP model, where decreased formation of cartilaginous and bony callus along with a reduction in the formation of endochondral and osteoblastic bone was noted.
Calcitonin gene-related peptides (CGRP) exist in two forms: α and β. α-CGRP originates from the Calca gene and consists of 37 amino acids. It shares 20% homology with calcitonin. It has been found that CGRP stimulates the proliferation and differentiation and reduces apoptosis of osteogenesis precursor cells. CGRP levels increase in patients with fractures, suggesting it plays an essential role during the inflammatory stage of bone healing and during the repair of damaged tissues. Mice with null α-CGRP levels developed osteopenia caused by decreased bone formation rates.
Osteogenic growth peptide (OGP) is a naturally occurring, highly conserved, 14-amino acid, histone H4-related peptide widely present in human and mammalian blood, as well as in culture mediums of osteoblasts and fibroblasts. OGP has been found to exert an anabolic effect on bone cells, leading to increased bone formation and overall bone mass. Experimental fracture healing models have shown that OGP could serve as a potential candidate for enhancing bone healing response.
Thrombin synthetic peptide 508 (chrysalin) represents a non-proteolytic receptor-binding domain of thrombin. TP508 mimics some specific properties of thrombin without the undesirable effects of blood clotting. It has been found that TP508 enhances proliferation and differentiation, induces chemotaxis in human osteoblasts, enhances angiogenesis, and mitigates the effects of chronic hypoxia. Several in vivo animal models have demonstrated that TP508 can exert an enhancing regulatory effect on bone healing.
Peptide P-15 consists of 15 amino acids identical to the cell-binding domain of type I collagen. P-15 enhances cell attachment to bone substitutes and activates the production of the extracellular matrix. Adding P-15 to the scaffold material leads to significantly higher gene expression of alkaline phosphatase (ALP), BMP-2, and BMP-7, promoting osteoblast activity.
A special questionnaire has been developed to identify risk factors for osteoporosis in patients, adapted for both men and women (Table 1).
Category | Factor | Yes | No |
---|---|---|---|
Family Factors | Parent(s) had fractures without obvious causes | ☐ | ☐ |
Parent(s) have a stooped posture | ☐ | ☐ | |
Personal Information | I am over 60 years old | ☐ | ☐ |
I am underweight or have had significant weight loss | ☐ | ☐ | |
I feel weak or ill | ☐ | ☐ | |
I am very thin | ☐ | ☐ | |
I had a bone fracture after the age of 50 | ☐ | ☐ | |
I have low bone density | ☐ | ☐ | |
Physical Constitution | I was not physically active in childhood | ☐ | ☐ |
I am not physically active now | ☐ | ☐ | |
I am bedridden or use a wheelchair | ☐ | ☐ | |
I spend less than half an hour in the sun daily | ☐ | ☐ | |
Questions for Women | Menopause started before 45 years of age | ☐ | ☐ |
Ovaries were removed surgically | ☐ | ☐ | |
I am a mother of several children | ☐ | ☐ | |
Questions for Men | I have low testosterone levels | ☐ | ☐ |
Diet | I rarely consume milk, cheese, and dairy products | ☐ | ☐ |
I rarely eat fresh green vegetables | ☐ | ☐ | |
I eat meat dishes daily | ☐ | ☐ | |
I often eat fast food or ready-made meals | ☐ | ☐ | |
I frequently and heavily consume sugar | ☐ | ☐ | |
Lifestyle | I smoke (one pack a day or more) | ☐ | ☐ |
I drink more than 4 cups of coffee a day | ☐ | ☐ | |
I consume more than 3 cans of Coca-Cola a day | ☐ | ☐ | |
I drink more than 2 alcoholic beverages a day | ☐ | ☐ | |
Diseases | I have hyperthyroidism | ☐ | ☐ |
I have chronic kidney or liver disease | ☐ | ☐ | |
I have an inflammatory bowel disease | ☐ | ☐ | |
I have diabetes | ☐ | ☐ | |
I often have digestive problems (bloating, diarrhea) | ☐ | ☐ |
Assessment of Results:
Sarcopenia Diagnosis
During the patient history collection stage, it is recommended to incorporate the SARC-F questionnaire (Sluggishness, Assistance in walking, Rise from a chair, Climb stairs, Falls) into clinical practice to timely identify muscle dysfunction (Table 2). A total score of more than 4 is considered a predictor of sarcopenia and is a basis for further assessment of muscle strength.
Component | Question | Assessment, Points |
---|---|---|
Strength | How much difficulty do you have lifting and carrying a weight of 4.5 kg (10 lbs)? | No – 0 Some – 1 Significant or unable – 2 |
Walking Assistance | How much difficulty do you have walking across a room? | No – 0 Some – 1 Significant, need assistance or unable – 2 |
Rising from Chair | How much difficulty do you have getting up from a chair or bed? | No – 0 Some – 1 Significant or unable without help – 2 |
Climbing Stairs | How much difficulty do you have climbing a flight of 10 stairs? | No – 0 Some – 1 Significant or unable – 2 |
Falls | How many times have you fallen in the last year? | Never – 0 1-3 times – 1 4 times or more – 2 |
Muscle strength is measured using handgrip dynamometry and the chair stand test. Low muscle strength (less than 16 kg for women and less than 27 kg for men) indicates a probable diagnosis of sarcopenia. In clinical practice, this is sufficient to commence treatment.
Confirmation of the sarcopenia diagnosis is conducted by determining muscle mass using:
A simple yet reliable method is measuring the arm circumference (3.14 × triceps skinfold thickness). Low muscle mass corresponds to an arm circumference of less than 21.1 cm for men and less than 19.2 cm for women.
Severity of sarcopenia is further determined based on physical performance:
The Short Physical Performance Battery (SPPB) includes tests for assessing walking speed, balance, and the chair stand test. These tests focus on lower limb function as it correlates with mobility, disability, and patient outcomes, including hospitalization and mortality.
The maximum score for this test is 12 points. A result of ≤ 7 points is a diagnostic criterion for the syndrome of frailty in the elderly.
A scale for assessing motor activity is used to identify the degree of mobility in the elderly (Table 3). Using this scale allows for an objective assessment by measuring those parameters of motor activity that change most with age: overall stability and gait changes.
Table 3 – Scale of Mobility Ability
Part 1: Overall Stability
Questions | Answer Options |
---|---|
Overall Stability | 0 points – Severe impairment, 1 point – Moderate impairment, 2 points – Normal |
Attempt to Stand | |
After Standing Up | |
Duration of Standing for 1 Minute | |
Standing Up from Lying Position | |
Push in the Chest | |
Standing with Eyes Closed | |
Stepping when Turning 360 Degrees | |
Stability when Turning 360 Degrees | |
Standing on Right Leg (5 sec) | |
Standing on Left Leg (5 sec) | |
Backward Bending | |
Reaching Up | |
Total Score for Part 1 |
Part 2: Walking and Gait Parameters
Questions | Answer Options |
---|---|
Initiation of Movement | 0 points – Severe impairment, 1 point – Moderate impairment, 2 points – Normal |
Step Symmetry | |
Continuity of Walking | |
Step Length (Left Leg) | |
Step Length (Right Leg) | |
Deviation from Movement Line | |
Degree of Trunk Sway | |
Turns while Walking | |
Voluntary Increase in Walking Speed | |
Step Height (Right Leg) | |
Step Height (Left Leg) | |
Total Score for Part 2 |
Total Score for Part 1: A range from 0 to 10 points corresponds to a significant degree of overall stability impairment, 11 to 21 points to a moderate degree of overall stability impairment, from 21 to 22 points to a mild impairment, and 23-24 points to normal stability.
Total Score for Part 2 (degree of gait impairment): 0-10 points – significant degree, 11-13 points – moderate, 14-15 points – mild, 16 points – normal.
Upon completion of the questionnaire, the scores obtained from the two sub-scales are summed up, with the overall total score ranging from 0 to 40, where 0-20 points indicate a significant degree of impairment in overall motor activity, 21-33 points – moderate, 34-38 points – mild, 39-40 points – normal.
Balance and Equilibrium Assessment (Flamingo Test) – the participant removes shoes and assumes the starting position: standing on one leg, the other knee is bent and its foot pressed against the inner side of the knee of the supporting leg, hands on the waist. When ready, the participant lifts the heel of the supporting leg off the ground, and the stopwatch is started. The task is to maintain this pose for as long as possible.
The stopwatch is stopped in the following cases: a) hand(s) were removed from the waist; b) a turn was made on the supporting leg in any direction; c) contact between the foot of the second leg and the knee of the supporting leg was lost; d) the heel of the supporting leg touched the ground.
Assessment of Results:
Performance Level | Duration |
---|---|
Very Low | 9 seconds or less |
Low | 10-24 seconds |
Medium | 25-39 seconds |
High | 40-50 seconds |
Very High | 51 seconds or more |
The validated screening scale FRAIL is used to identify frailty in the elderly (Table 4).
Table 4 – FRAIL Scale
Acronym | Description |
---|---|
Fatigue | Feeling tired most of the time in the last 4 weeks |
Resistance | Difficulty or inability to climb a flight of stairs |
Ambulation | Difficulty or inability to walk a block |
Illness | Having more than 5 diseases |
Loss of Weight | Loss of more than 5% of previous body weight in the last 6 months |
The presence of three or more positive responses indicates frailty, while one or two positive responses suggest pre-frailty.
Nutritional-metabolic support is one of the key aspects in maintaining adequate functioning of the musculoskeletal system. Consumption of high-protein food, alongside lifestyle normalization, abstaining from harmful habits, and maintaining an adequate level of physical activity, is essential for muscle protein synthesis. Under specific conditions (such as gastrointestinal tract function disorders, post-stroke conditions, etc.), the use of oral nutritional supplements in the form of sipping products can provide patients with sufficient amounts of protein substrates when they are unable to consume them independently.
This section provides examples of daily diets for primary pathologies of the motor domain (the daily caloric content of the diets can be proportionally adjusted by a physician if necessary).
Diet for Sarcopenia (~2200 kcal/day)
Day | Meal | Menu |
---|---|---|
Monday | Breakfast (8:00-8:30) | Chicken sandwich (2 slices of bread) + 200 ml 2.5% milk |
Snack (11:00-11:30) | Fruit salad (150 g) + 5% cottage cheese (100 g) | |
Lunch (14:00-14:30) | Rice (150 g) + soy pieces ragout (200 g) + 5% cottage cheese (100 g) | |
Snack (16:00-16:30) | 1 cup of tea + vegetable and boiled chicken salad (200 g) | |
Dinner (19:00-19:30) | Pasta with shrimp (200 g) | |
Tuesday | Breakfast (8:00-8:30) | Brussels sprouts (150 g) + 2 boiled eggs + 1 cup of tea |
Snack (11:00-11:30) | A handful of nuts (30 g) | |
Lunch (14:00-14:30) | Rice (150 g) + chicken ragout (150 g) + 5% cottage cheese (100 g) | |
Snack (16:00-16:30) | Fruit salad (150 g) + Greek yogurt (50 g) | |
Dinner (19:00-19:30) | Bulgur (150 g) + braised green beans (150 g) | |
Wednesday | Breakfast (8:00-8:30) | Sunny-side-up eggs (2 eggs) + buckwheat crispbread + 200 ml 2.5% milk |
Snack (11:00-11:30) | Fruit salad (150 g) + 5% cottage cheese (100 g) | |
Lunch (14:00-14:30) | Buckwheat groats (100 g) + bean ragout (150 g) + cucumber and tomato salad (150 g) | |
Snack (16:00-16:30) | 1 cup of tea + a handful of nuts (30 g) | |
Dinner (19:00-19:30) | Wheat groats (100 g) + fish patties (150 g) | |
Thursday | Breakfast (8:00-8:30) | Omelet with tomatoes and mushrooms (200 g) + cheese sandwich |
Snack (11:00-11:30) | 1 banana + almond milkshake | |
Lunch (14:00-14:30) | Rice (100 g) + baked salmon (150 g) + tomato (100 g) | |
Snack (16:00-16:30) | Yogurt with cereals (50 g) | |
Dinner (19:00-19:30) | Bulgur (100 g) + vegetable ragout (150 g) | |
Friday | Breakfast (8:00-8:30) | Scrambled eggs with avocado and tomato (200 g) |
Snack (11:00-11:30) | 1 cup of tea + a handful of nuts (30 g) | |
Lunch (14:00-14:30) | Rice (100 g) + beef goulash (150 g) | |
Snack (16:00-16:30) | 1 cup of tea + 5% cottage cheese (150 g) | |
Dinner (19:00-19:30) | Fish soup (250 ml) | |
Saturday | Breakfast (8:00-8:30) | Cheese sandwich (2 pcs) + 200 ml 2.5% milk |
Snack (11:00-11:30) | 1 cup of tea + 30 g dates | |
Lunch (14:00-14:30) | Hummus (100 g) + grilled chicken (150 g) + cucumber salad (150 g) | |
Snack (16:00-16:30) | 1 cup of tea + protein bar | |
Dinner (19:00-19:30) | Buckwheat groats (100 g) + bean ragout (150 g) | |
Sunday | Breakfast (8:00-8:30) | 2 boiled eggs + green sprouts (150 g) |
Snack (11:00-11:30) | 1 cup of tea + 50 g cheese | |
Lunch (14:00-14:30) | Brown rice (100 g) + baked fish (180 g) + Caesar salad (150 g) | |
Snack (16:00-16:30) | 1 portion of fruits + 5% cottage cheese (100 g) | |
Dinner (19:00-19:30) | Chicken soup in vegetable broth (250 ml) |
Diet for Osteoarthritis (~1800 kcal/day)
Day | Meal Time | Menu |
---|---|---|
Monday | Breakfast (8:00-8:30) | Omelet with 2.5% milk (2 eggs) |
Snack (11:00-11:30) | Green sprouts (150 g) | |
Lunch (14:00-14:30) | Bulgur (100 g) + Baked salmon (100 g) + Greek salad (150 g) | |
Snack (16:00-16:30) | Choice of fruits: pineapple, blueberry, orange, apple, cherry (150 g) | |
Dinner (19:00-19:30) | Wheat groats (100 g) + Chicken patty (150 g) | |
Tuesday | Breakfast (8:00-8:30) | Oatmeal on skim milk + 1 cup of tea |
Snack (11:00-11:30) | Choice of fruits: pineapple, blueberry, orange, apple, cherry (150 g) | |
Lunch (14:00-14:30) | Rice (100 g) + Fish patty (75 g) + Seaweed salad (50 g) | |
Snack (16:00-16:30) | A handful of nuts (30 g) | |
Dinner (19:00-19:30) | Chicken soup on vegetable broth (200 ml) | |
Wednesday | Breakfast (8:00-8:30) | 2 boiled eggs + 1 cheese sandwich + 1 cup of tea |
Snack (11:00-11:30) | Choice of fruits: pineapple, blueberry, orange, apple, cherry (150 g) | |
Lunch (14:00-14:30) | Brown rice (100 g) + Chicken breast ragout (100 g) | |
Snack (16:00-16:30) | 1 glass of skim milk | |
Dinner (19:00-19:30) | Baked sea fish (100 g) + Braised green beans (150 g) | |
Thursday | Breakfast (8:00-8:30) | Scrambled eggs with tomato (200 g) + 2 slices of hard cheese (20 g) |
Snack (11:00-11:30) | 5% cottage cheese (100 g) | |
Lunch (14:00-14:30) | Buckwheat groats (100 g) + Salad with tuna and cabbage (80 g tuna) | |
Snack (16:00-16:30) | Choice of fruits: pineapple, blueberry, orange, apple, cherry (150 g) | |
Dinner (19:00-19:30) | Vegetable ragout (150 g) + Fish patty (75 g) | |
Friday | Breakfast (8:00-8:30) | Oatmeal 150 g + 1 boiled egg |
Snack (11:00-11:30) | Choice of fruits: pineapple, blueberry, orange, apple, cherry (150 g) | |
Lunch (14:00-14:30) | Bulgur (100 g) + Beef goulash (100 g) + Celery salad (150 g) | |
Snack (16:00-16:30) | 1 glass of milk with walnuts | |
Dinner (19:00-19:30) | Fish soup (250 ml) | |
Saturday | Breakfast (8:00-8:30) | Cheese pancakes (150 g) + 1 cup of tea |
Snack (11:00-11:30) | A handful of nuts (30 g) | |
Lunch (14:00-14:30) | Brown rice (100 g) + Baked fish (mackerel 100 g) + Salad of cucumbers and cabbage (150 g) | |
Snack (16:00-16:30) | Fruit salad (150 g) + Yogurt | |
Dinner (19:00-19:30) | Soup with vegetables and chicken breast (250 ml) |
Osteoporosis Diet Plan (Approx. 2500 kcal/day)
Day | Meal Time | Menu |
---|---|---|
Monday | Breakfast (8:00-8:30) | Oatmeal on 2.5% milk (150 g) + 2 cashew nuts + 5-6 almonds + 3-4 raisins |
Snack (11:00-11:30) | Greek yogurt (100 g) + 1 baked apple | |
Lunch (14:00-14:30) | Bulgur (100 g) + baked salmon (100 g) + ‘Vegetable’ salad (150 g) | |
Snack (16:00-16:30) | Rice cereal bar (1 piece) + green tea (1 cup) | |
Dinner (19:00-19:30) | Buckwheat groats (100 g) + beef stew (150 g) | |
Tuesday | Breakfast (8:00-8:30) | Steamed Brussels sprouts with green onions (150 g) + green tea (1 cup) with honey (1 tsp) + 2 cashew nuts + 5-6 almonds |
Snack (11:00-11:30) | Choice of fruits: pineapple, blueberry, orange, apple, cherry (150 g) | |
Lunch (14:00-14:30) | Pasta with shrimp (200 g) + seaweed salad (100 g) | |
Snack (16:00-16:30) | Boiled corn and carrots (1/2 cup) + green tea (1 cup) | |
Dinner (19:00-19:30) | Lentil puree soup on chicken broth (300 g) | |
Wednesday | Breakfast (8:00-8:30) | Couscous on 2.5% milk with fruit pieces (200 g) |
Snack (11:00-11:30) | 2.5% milk (200 ml) + 2 dates | |
Lunch (14:00-14:30) | Buckwheat groats (100 g) + beef stew (150 g) | |
Snack (16:00-16:30) | Choice of fruits: pineapple, blueberry, orange, apple, cherry (150 g) | |
Dinner (19:00-19:30) | Baked vegetables (beetroot, eggplants, zucchini, tomatoes, peppers, 200 g) + bean puree (100 g) | |
Thursday | Breakfast (8:00-8:30) | Scrambled eggs with roasted tomatoes (150 g) + green tea (1 cup) with honey (1 tsp) |
Snack (11:00-11:30) | A handful of nuts (40 g) | |
Lunch (14:00-14:30) | Pasta with mozzarella (100 g) + baked trout (100 g) | |
Snack (16:00-16:30) | Choice of fruits: pineapple, blueberry, orange, apple, cherry (150 g) | |
Dinner (19:00-19:30) | Brown rice (100 g) + stewed pollock (150 g) | |
Friday | Breakfast (8:00-8:30) | Broccoli with green onions and mushroom soup (1 cup) + 2 cashew nuts + 5-6 almonds + 3-4 raisins |
Snack (11:00-11:30) | Choice of fruits: pineapple, blueberry, orange, apple, cherry (150 g) | |
Lunch (14:00-14:30) | Vegetable stew (200 g) with sea fish (100 g) | |
Snack (16:00-16:30) | Boiled corn and carrots (150 g) + green tea (1 cup) | |
Dinner (19:00-19:30) | Steamed turkey patties (100 g) + baked potato (100 g) | |
Saturday | Breakfast (8:00-8:30) | Omelette (2 eggs and 60 ml of 2.5% milk) with spinach (180 g), basil, and tomato (100 g) |
Snack (11:00-11:30) | Choice of fruits: pineapple, blueberry, orange, apple, cherry (150 g) | |
Lunch (14:00-14:30) | Pasta with zucchini (150 g) + ‘Greek’ salad with feta cheese (150 g) | |
Snack (16:00-16:30) | 2.5% milk (200 ml) + 1 oatmeal cookie | |
Dinner (19:00-19:30) | Baked sea fish (100 g) + braised green beans (150 g) | |
Sunday | Breakfast (8:00-8:30) | Poached eggs (2) + whole grain bread toasts (2 slices) |
Snack (11:00-11:30) | Choice of fruits: pineapple, blueberry, orange, apple, cherry (150 g) | |
Lunch (14:00-14:30) | Vegetable soup (200 ml) + hummus (50 g) + 1 slice of whole grain bread | |
Snack (16:00-16:30) | A handful of nuts (40 g) | |
Dinner (19:00-19:30) | Stewed chicken with mushrooms and green beans (200 g) |
Recent systematic meta-analyses have shown that weight loss combined with therapeutic exercise reduces pain, improves joint function, and positively affects structural changes in cartilage and biochemical markers of cartilage and bone metabolism. Large-scale study results convincingly demonstrated that a 1% weight loss reduces the risk of total knee arthroplasty by 2%.
According to the latest WHO recommendations on physical activity and sedentary lifestyle, the required amount of time for moderate-intensity aerobic physical activity is at least 150-300 minutes per week; for high-intensity – at least 75-150 minutes per week; or a combination of moderate and high-intensity physical activity throughout the week, as this brings additional health benefits. It is essential to organize time so that sitting or lying down is replaced by physically active behavior of any intensity (including low intensity).
The necessary training effect on the cardiovascular system and metabolism is achieved at a heart rate of 70-85% of the maximum permissible values (calculated individually using the formula: 220 – Age).
Older adults are advised to engage in diverse multi-component physical activities three times a week or more, focusing on balance improvement and moderate to high-intensity strength training to enhance functional abilities and prevent falls. It is important to remember that physical exercises should be adequate to a person’s actual capabilities.
There are some specific features of physical exercises for mobility impairments: firstly, exercises should be performed without static loads (sitting, lying); an alternative is exercises in the pool, swimming 2-3 times a week in freestyle. Secondly, therapeutic exercises should be repeated frequently throughout the day (10-15 minutes several times, at least 30-40 minutes in total). Avoid exercises that cause pain. Perform exercises slowly, smoothly, gradually increasing the load.
The assessment of health status, assignment of diagnostic methods, interpretation of obtained data, and determination of indications for pharmacological and non-pharmacological treatments at the initial stage of outpatient care are conducted by primary care physicians (general practitioners or family doctors).
Observation by a general practitioner, gynecologist (for women) is recommended at least once or twice a year, by specialists – as indicated. Annual health check-ups and sanatorium-resort treatments are advised.
Continuing the theme of dietary correction and enhancing individual vitality, based on the aforementioned information, it is evident that the main focus should be on peptides. The appetite regulation center is located in the hypothalamus, which is maintained through complex interactions between the ventromedial hypothalamic nucleus (satiety center), lateral hypothalamus (hunger center), and arcuate nucleus. Due to the evolutionary age-related changes, there is a change in activity and sensitivity to peptides that regulate appetite and nutrition, which is an important factor in reducing appetite and individual vitality.
VIRUIN_PROartro is a specially designed dietary supplement aimed at supporting the natural mechanisms of joint cartilage recovery and preventing further destruction.
6.3.4.1. Composition of the Nutriceutical and the Action Mechanism of its Components The ingredient composition of VIRUIN-PROartro includes D-glucosamine sulfate, potassium chloride, Methylsulfonylmethane + peptide complex IPH AEN, hypromellose.
Peptide complex IPH AEN is a new generation bioregulator with chondro- and osteoprotective properties, normalizing the action on cartilaginous and bone tissue. It is a natural metabolite, familiar to the body. Experimental studies have shown that the peptide complex IPH-AEN:
Methylsulfonylmethane (MSM) is a natural compound, a source of organic sulfur.
D-glucosamine sulfate
Potassium chloride
Adults are recommended to take 1 capsule orally three times a day with meals. The course of intake is for 2-3 months, twice a year.
Indications: restoration of joints, ligaments, and the musculoskeletal system. The components included in the composition have anti-inflammatory, antioxidant, and anti-allergenic effects, contribute to the restoration of connective tissue, participate in the formation of the ligamentous apparatus and bone system.
Degenerative-dystrophic changes in the musculoskeletal system are among the most common and significant pathologies, especially in the older age group.
Timely disease detection, appropriately prescribed pharmacotherapy, and active patient involvement in the treatment process (explaining the need for lifestyle changes, weight loss, physical exercises, and dietary correction) significantly contribute to reducing the severity of the pathological process.
Research in the field of peptidology is a promising scientific direction in modern medicine. Peptide support for therapeutic and preventive programs for patients with musculoskeletal diseases and the risk of their development will contribute to improving the effectiveness of care, patient functionality, and quality of life.