İskelet kasları gündelik yaşamda her hareketimizden ve çevreyle olan her etkileşimimizden sorumludur. Konuyu daha iyi anlayabilmek için, bir sandalyeden kalkmak, besinleri ağzımıza götürmek, onları çiğnemek, yutmak, solunum ve dolaşımı gerçekleştirmek, sindirim sisteminin düzenli çalışması gibi fiziksel eylemlerin hepsi iskelet kaslarının başarılı çalışmasına bağlıdır. Ancak, iskelet kaslarının sağlıklı kalabilmeleri ve düzenli çalışabilmeleri oldukça sistematik bir çalışma gerektirir. Spesifik olarak bazı sinir-kas hastalıkları (MS, fibromiyalji gibi) kaynaklı bozulmaların yanı sıra yaşa bağlı olarak da iskelet kaslarının hem yapısal hem de fonksiyonel bozulmaları deneyimlenmektedir. Özellikle bu durum modern toplumlarda artan sedantarizm düzeyi ile yakın ilişkili bir şekilde göze çarpmaktadır. İngiltere’ de yapılan bir araştırmada özelikle ileri yaşlarda (80-90 yaş aralığı) hastane ve hemşire bakımı gibi sağlık hizmetlerine ihtiyaç duyan kişilerin yaklaşık %25’ inin bu durumlarının nedeni olarak mobilite eksikliği ve hareketsizlik kaynaklı olduğu vurgulanmıştır (Ojanen ve ark., 2007; Office of Fair Trading, 2005; Bajekal ve ark., 2006). Aynı zamanda, iskelet kaslarının fonksiyon düzeyi ile hastane bakımı, engellilik ve hatta ölüm riski arasında yüksek korelasyon olduğu iddia edilmektedir (Newman ve ark., 2006). Bundan dolayı, özellikle iskelet kasında meydana gelen yapısal ve fonksiyonel değişimlerin muhtemel etkileri ve bu etkilerin rasyonel mekanizmalarını anlamak son derece değerli olacaktır.
İskelet kasının yaşlılıkta azalmasına işaret eden tarihi ve gözlemsel çıkarımlar Aristotales’ den Sheakspear’e kadar uzanmıştır (Narici ve Muaffulli, 2010). Ancak, yaşla birlikte iskelet kasında meydana gelen yapısal azalmaların yüksek teknoloji ile tespiti görece olarak henüz yeni bir dönemde (yaklaşık 50 yıl önce) gerçekleşmiştir. Bu detaylı ölçümler sonucunda 20-30’ lu yaşlar ile 70’ li yaşlardaki bireylerin iskelet kas oranları karşılaştırmaları son derece hassas yöntemlerle belirlenmiştir. Bu bağlamda, yaş bağlı olarak kas kütlesi kayıpları iyi dokümente edilmiş bir konudur (Mitchell ve ark., 2012).
Sarkopeni kavramı, ilk kez Rosenberg (1989) tarafından Yunanca “sarcos” ve “penia” kavramlarından türemiş bir fenomendir. Tam olarak anlamı kas kaybı olarak çevrilmektedir. Aynı zamanda, sarkopeni kavramı, bilimsel toplum ve klinisyenler arasında herhangi bir patolojik problemi olmayan ve yaşa bağlı olarak azalan iskelet kas oranında görülen azalmaları ifade etmektedir. Literatür açısından bir diğer tanımlama biçimi ise, temelde yağsız kas ağırlığında görülen azalma ile birlikte kuvvet üretme potansiyelinde yaşanan düşüşlerin tanımlanması içinde kullanılmaktadır. Ancak bu durum biraz tartışmalıdır (Morley ve ark., 2001; Cruz-Jentoft ve ark., 2010). Ayrıca, bazı bilim insanları sarkopeni kavramını “geriatrik sendrom” olarak nitelendirmektedir (Cruz-Jentoft ve ark., 2010). Geriatrik sendrom kavramının kullanım nedeni olarak, yaşa bağlı olarak bireylerde düşme, hezeyan, idrar kaçırma ve kemiklerde kırılganlık gibi faktörlerde görülen artışlar gösterilmektedir.
İskelet Kasında Yaşa Bağlı Meydana Gelen Değişimler
Literatür açısından yaşa bağlı olarak meydana gelen iskelet kas kayıpları oranı üzerine tam bir konsensüs henüz oluşmamıştır. Literatürün üzerinde mutabık olduğu en önemli fenomen yaşa bağlı olarak iskelet kasında meydana gelen hacimsel azalmalardır. Yaşa bağlı olarak iskelet kasında meydana gelen azalma oranı olarak sıralı şekilde 18-80 yaş aralığında %8 – 49 arasında olduğu düşünülmektedir (Tzankoff ve Norris, 1977; Novak, 1972). Ancak, özellikle yaşa bağlı iskelet kası hacminde görülen azalmaları inceleyen araştırmalardan oluşan derlemelerde ortalama her on yılda görülen sarkopenik etkinin kadınlarda %3.7 ve erkeklerde ise %4.7 olduğu rapor edilmiştir (Mitchell ve ark., 2012). Ayrıca, literatür açısından sarkopenik etkinin başlama yılı açısından da bir birliktelik bulunmamaktadır. Literatür incelendiğinde, bir araştırmada sarkopenik etkinin başlama yaşı olarak 27 yaş (Silva ve ark., 2009), başka bir araştırmada 45 yaş (Janssen et al., 2000) ve bir diğer araştırma da ise 60 yaş olarak ifade edilmiştir (Kyle ve ark., 2001). Araştırma sonuçlarında görülen bu tutarsızlığın kaynağı olarak kas kütlesini belirleme yöntemleri gösterilmektedir. Kadın ve erkekler açısından sarkopenik etkinin karşılaştırıldığı çalışmalarda erkeklerin kadınlara göre daha yüksek sarkopenik etkiye sahip oldukları saptanmıştır (Gallagher ve ark.,1997). Ayrıca, kadınlar açısından da menapoz dönemi sarkopenik etkinin daha fazla olduğu bildirilmiştir (Sirola ve Kroger, 2011).
Sarkopeninin muhtemel etkilerinin anlaşılması yaklaşık 20-30 yıl öncesine dayanmaktadır. Bazı araştırmacılar tarafından, yaşla birlikte artan sarkopenik etki ile fonksiyon kayıplarında, hastalık gelişme ve engellilik riskinde artışlar olabileceği iddia edilmiştir (Evans, 1995; Frontera ve ark., 1991). Dahası, Landi ve ark., (2005) tarafından yapılan bir araştırmada, basit bir kol çevresi ölçümü değerlerinin kıyaslandığı katılımcılar arasında kol çevresi düşük olanlar yüksek olanlara kıyasla daha dazla ölüm riskine sahip oldukları saptanmıştır. Ancak, literatürde bazı araştırmalarda yaşa bağlı azalan kas kütlesi ve fonksiyonun mortalite ile ilişkili olmadığı da bildirilmiştir (Visser ve ark., 1998a; 1998b; 2005). Sarkopeninin etkilerini daha iyi açıklamak için yapılan araştırmalarda sadece iskelet kaslarının boyutlarında bir azalmanın gerçekleşmediği aynı zamanda kas kuvvetinde ve fiziksel performans düzeyinde de azalmaların olduğu rapor edilmiştir. Ayrıca, yaşa bağlı olarak meydana gelen iskelet kası kayıplarının tek başına pre-sarkopeniye neden olduğu devamında görülen kas kuvveti ve fiziksel performans kayıpları ile sarkopeninin geliştiği de vurgulanmıştır (Cruz-Jentoft ve ark., 2010). Bu yaklaşım tek başına kabul görmemesine rağmen kullanılmaktadır. Aynı zamanda, iskelet kası kayıplarına eşlik eden kas kuvveti ve fonksiyon düşüşleri “dinapenia” olarak adlandırılmaktadır. Dinapenia kavramı da henüz bilimsel toplum tarafından tam bir konsensüs içerisinde kullanılmamasına rağmen kas-sinir birlikteliğini temsil eden nöro-musküler yapının fonksiyon kayıplarından ortaya çıkmıştır (Clark ve Manini, 2008).
Literatür açısından tartışmalı olarak kabul edebileceğimiz sarkopeni ile yaşam beklentisi arasındaki ilişkinin varlığı bizim konuya soru işareti koymamızı ve mümkün olduğu kadar sarkopenik etkiden kendimizi korumamız gerektiğini işaret etmektedir. Bu nedenle, yaşam beklentisi ile sakopeni arasında her ne kadar henüz güçlü ilişki kuramasak da sağlıklı ve özgür bir yaşlılık için kas kütlesini korumak genel kabulümüz olarak düşünülebilir. Bu noktada, yaşa bağlı olarak sarkopeni ve dinapeni önleme stratejileri genel olarak hareket ve beslenme üzerine yoğunlaşmıştır. Bu stratejiler;
- Fiziksel aktif olmak
- Uzun süreli hareketsizlikten kaçınmak
- Düşme riskini minimize etmek
- Protein yoksunluğu yaşamamak
- Esansiyel aminoasit içeren besinleri tüketmek
- Paketlenmiş işlenmiş yiyeceklerden uzak durmak
- Düzenli egzersiz yapmak
- Direnç egzersizi yapmak 2-3/hafta
- Stabilite-Mobilite egzersizleri yapmak 1-2/hafta
- Denge egzersizleri yapmak 1/hafta
- Yüzme egzersizi yapmak 2-3/ay
Haftanın Mottosu: “Gençlikte günler kısa yollar uzundur. Yaşlılıkta yollar kısa günler uzundur – Immanuel Kant”
Çok yararlı ve yol gösterici bir yazı. Egzersizlere devam..
Teşekkür ederim.
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