Strong@HOME - Development of an innovative technological solution of telemedicine for the prevention, early diagnosis, monitoring and treatment of sarcopenia

Strength, power, and muscle mass are critical variables influencing the quality of daily life during aging. Their decline can lead to impaired motor function, resulting in an increased risk of falls and fractures, cardiovascular and respiratory diseases, cognitive deterioration, and reduced ability to perform everyday activities. This sets off a vicious cycle that may trigger various adverse outcomes, including loss of independence, the need for long-term care, and, in a cascade of events, even death. This process is identified as a geriatric syndrome known as sarcopenia. Sarcopenia is a progressive musculoskeletal disorder characterized by deficits in three primary aspects: muscle strength, muscle mass quantity and quality, and physical performance levels. The definition of sarcopenia was first established in 2010 and subsequently updated, along with diagnostic cut-off points, in 2018 by the European Working Group on Sarcopenia in Older People. A diagnostic process has been identified step by step by passing from a clinical suspicion to the identification of severe state of the disease. Specifically, it starts by administering a questionnaire (SARC-F) that investigates 5 items: muscle strength, need for assistance in walking, difficulty in getting up from a chair, difficulty in climbing stairs and the number of falls in the last year. These aspects are all correlated with the loss of muscle mass, strength and power. In case of suspected disease, the diagnosis continues by carrying out direct assessments about strength (handgrip, chair stand test, isokinetic dynamometer), quality / quantity of muscle mass (in particular index of the appendages) and physical function (SPPB, gait speed, TUG, 400m walk). Evidence-based clinical guidelines strongly recommend physical activity as the primary treatment for sarcopenia. Resistance exercise, in particular, has been shown to effectively improve skeletal muscle strength and mass, resulting in significant benefits for the prevention and treatment of sarcopenia. However, the high costs and limited accessibility of diagnostic tools and supervised exercise programs for potentially immobile individuals make this condition underdiagnosed and undertreated. Early identification of individuals at risk, early diagnosis, and targeted exercise therapy can significantly reduce the social and individual burden of this sentinel condition and disrupt the vicious cycle it perpetuates. In this context, recent technological advancements and the application of the Internet of Things to health and wellness devices offer extraordinary opportunities to prevent and treat various conditions autonomously and sustainably, directly in individuals' homes. In response to this, the Exercise Physiology Laboratory at the University of Verona initiated a collaboration with Corehab, a company that developed the web-based Kari® system for neuromotor rehabilitation and remote training. This doctoral thesis aligns with the goals of this university-industry partnership, which seeks to develop and validate this innovative, low-cost telemedicine solution to promote health and individual autonomy among aging populations. The main aim of this project is to investigate the feasibility and efficacy of the Kari® telemedicine system in delivering six months of self-administered resistance exercises at home in older adults. Additionally, the research project aims to pursue the following secondary objectives: (i) to develop a field test for characterizing lower-limb muscle function (strength and power) in older adults; (ii) to verify the accuracy of muscle power measurements using a wearable IMU sensor during the 5 sit-to-stand test. Chapter one explores the concepts, impacts, causes, and prevention strategies for frailty in older adults, with a particular focus on muscle function during aging. Chapter two illustrates the research aims of this thesis. Chapters three, four, five, and six report the results from four experimental studies conducted over the three years of this doctoral journey. Finally, chapter seven summarizes the thesis findings.