PREDICCIÓN DE SARCOPENIA MEDIANTE LA FUERZA DE AGARRE DE MANO EN ADULTOS MAYORES.
Palabras clave:
Adulto mayor, Sarcopenia, Dinamometría, Fuerza de Agarre de Mano.
Resumen
Objetivo: Determinar si la fuerza de agarre de mano puede ser un método predictor de sarcopenia en adultos mayores. Método: Se realizó una búsqueda bibliográfica en la base de datos electrónica PUBMED, incluyendo estudios clínicos en humanos realizados en los últimos 5 años. Resultados y conclusión: Se incluyeron 9 estudios que utilizaron la fuerza de agarre de mano para la detección de sarcopenia en adultos mayores. Se encontró que la sarcopenia es una patología multifactorial, caracterizada por una baja fuerza (dinapenia) y masa músculo esquelética en quienes presentan dicha patología. La fuerza de agarre de mano ha demostrado ser un método valido, fiable con una fácil aplicabilidad para predecir la sarcopenia en adultos mayores independiente de la fuerza muscular de los miembros inferiores.
Citas
1. OMS. Organizacion Mundial de la Salud 2017 [
2. INE. Instituto Nacional de Estadística de Chile. Enfoque estadístico: Población adulta mayor en el bicentenario. Gobierno de Chile, Instituto Nacional de Estadística de Chile. Santiago, Chile.2010.
3. Albala C, Araya A, Barnett C, Borzuztku A, Bonout D, Castro S, et al. Situación demográfica en Chile. Manual Geriatría y Gerontología 2000.
4. Pérez V, Sierra F. Biología del envejecimiento. Revista médica de Chile. 2009;137:296-302.
5. SENAMA. Servicio Nacional de adulto mayor, Chile2011 [Available from: www.senama.cl/filesapp/cuentapublica2011.
6. Lopez J, Izquierdo, M., . Aspectos fisiológicos del ejercicio en relación al envejecimiento. In: Lopez J, Fernández, A., , editor. Fisiología del ejercicio. Madrid, España: Panamericana; 2006. p. 613-39.
7. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosisReport of the European Working Group on Sarcopenia in Older PeopleA. J. Cruz-Gentoft et al. Age and Ageing. 2010;39(4):412-23.
8. Delmonico MJ, Harris TB, Lee J-S, Visser M, Nevitt M, Kritchevsky SB, et al. Alternative Definitions of Sarcopenia, Lower Extremity Performance, and Functional Impairment with Aging in Older Men and Women. Journal of the American Geriatrics Society. 2007;55(5):769-74.
9. Goodpaster BH, Park SW, Harris TB, Kritchevsky SB, Nevitt M, Schwartz AV, et al. The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. The journals of gerontology Series A, Biological sciences and medical sciences. 2006;61(10):1059-64.
10. Peña G, Bustamante L , Ramírez M , Halley E , García L Evaluación de la ingesta proteica y la actividad física asociada con la sarcopenia del adulto mayor. Spanish Journal of Human
Nutrition and Dietetics. 2016;20(1):16 – 22.
11. García de Lorenzo y Mateos A, Álvarez J, De Man F. Envejecimiento y desnutrición: un reto para la sostenibilidad del SNS; conclusiones del IX Foro de Debate Abbott-SENPE. Nutrición Hospitalaria. 2012;27:1060-4.
12. Nieuwenhuizen WF, Weenen H, Rigby P, Hetherington MM. Older adults and patients in need of nutritional support: Review of current treatment options and factors influencing nutritional intake. Clinical Nutrition. 2010;29(2):160-9.
13. Janssen I, Heymsfield SB, Ross R. Low Relative Skeletal Muscle Mass (Sarcopenia) in Older Persons Is Associated with Functional Impairment and Physical Disability. Journal of the American Geriatrics Society. 2002;50(5):889-96.
14. Padilla C, Sánchez P, Cuevas M. Beneficios del entrenamiento de fuerza para la prevención y tratamiento de la sarcopenia. Nutrición Hospitalaria. 2014;29:979-88.
15. Lopez. J, Fernandez A. Fisiologia del Ejercicio. 3° ed. 3°, editor. Madrid, España: Editorial Panamericana; 2006.
16. Argilés JM, Busquets S, López-Soriano FJ, Figueras M. Fisiología de la sarcopenia: Similitudes y diferencias con la caquexia neoplásica. Nutrición Hospitalaria. 2006;21:38-45.
17. Feldman HA, Longcope C, Derby CA, Johannes CB, Araujo AB, Coviello AD, et al. Age Trends in the Level of Serum Testosterone and Other Hormones in Middle-Aged Men: Longitudinal Results from the Massachusetts Male Aging Study. The Journal of Clinical Endocrinology & Metabolism. 2002;87(2):589-98.
18. Adamo ML, Farrar RP. Resistance training, and IGF involvement in the maintenance of muscle mass during the aging process. Ageing Research Reviews. 2006;5(3):310-31.
19. Peake J, Gatta PD, Cameron-Smith D. Aging and its effects on inflammation in skeletal muscle at rest and following exercise-induced muscle injury. American Journal of Physiology - Regulatory, Integrative and Comparative Physiology. 2010;298(6):R1485-R95.
20. Laviano A, Meguid MM, Preziosa I, Fanelli FR. Oxidative stress and wasting in cancer. Current Opinion in Clinical Nutrition & Metabolic Care. 2007;10(4):449-56.
21. Evans WJ, Morley JE, Argilés J, Bales C, Baracos V, Guttridge D, et al. Cachexia: A new definition. Clinical Nutrition. 2008;27(6):793-9.
22. Lázaro M, et al.,. Nuevas tablas de fuerza de la mano para población adulta de Teruel. Nutrición Hospitalaria. 2008;23:35-40.
23. Choudhri A, Siddiqui A, Khan N, Cohen H. Understanding bibliometric
parameters and analysis. Radiographics : a review publication of the Radiological Society of North America. Inc. 2015;35(3).736-46.
24. Cramer JT, Cruz-Jentoft AJ, Landi F, Hickson M, Zamboni M, Pereira SL, et al. Impacts of High-Protein Oral Nutritional Supplements Among Malnourished Men and Women with Sarcopenia: A Multicenter, Randomized, Double-Blinded, Controlled Trial. Journal of the American Medical Directors Association. 2017;17(11):1044-55.
25. Rooks D, Praestgaard J, Hariry S, Laurent D, Petricoul O, Perry RG, et al. Treatment of Sarcopenia with Bimagrumab: Results from a Phase II, Randomized, Controlled, Proof-of-Concept Study. Journal of the American Geriatrics Society. 2017;65(9):1988-95.
26. Hassan BH, Hewitt J, Keogh JWL, Bermeo S, Duque G, Henwood TR. Impact of resistance training on sarcopenia in nursing care facilities: A pilot study. Geriatric Nursing.37(2):116-21.
27. Gariballa S, Alessa A. Sarcopenia: Prevalence and prognostic significance in hospitalized patients. Clinical Nutrition. 2013;32(5):772-6.
28. Di Monaco M, Castiglioni C, De Toma E, Gardin L, Giordano S, Di Monaco R, et al. Presarcopenia and sarcopenia in hip-fracture women: prevalence and association with ability to function in activities of daily living. Aging Clinical and Experimental Research. 2015;27(4):465-72.
29. Bischoff-Ferrari HA, Orav JE, Kanis JA, Rizzoli R, Schlögl M, Staehelin HB, et al. Comparative performance of current definitions of sarcopenia against the prospective incidence of falls among community-dwelling seniors age 65 and older. Osteoporosis International. 2015;26(12):2793-802.
30. Drey M, Sieber CC, Bertsch T, Bauer JM, Schmidmaier R. Osteosarcopenia is more than sarcopenia and osteopenia alone. Aging Clinical and Experimental Research. 2016;28(5):895-9.
31. Bjorkman MP, Suominen MH, Pitkälä KH, Finne-Soveri HU, Tilvis RS. Porvoo sarcopenia and nutrition trial: effects of protein supplementation on functional performance in home-dwelling sarcopenic older people - study protocol for a randomized controlled trial. Trials. 2013;14(1):387.
32. Malafarina V, Uriz-Otano F, Gil-Guerrero L, Iniesta R, Zulet MA, Martinez JA. Study protocol: High-protein nutritional intervention based on β-hydroxy-β-methylbutirate, vitamin D3 and calcium on obese and lean aged patients with hip fractures and sarcopenia. The HIPERPROT-GER study. Maturitas.76(2):123-8.
33. Laurentani F, Russo, C., Bandinelli, S., et al. Age-associated changes in skeletal muscles and their effect
on mobility: an operational diagnosis of sarcopenia. J Appl Physiol. 2003;95:1851-60.
34. Lenardt M, Binotto M, Hammerschmidt N, Cechinel C, Betiolli S, Lourenc T. Handgrip strength and physical activity in frail elderly. Da escola de Enfermagem Da USP. 2016;50(1):86-92.
35. Hamer M, et al., . Sarcopenic obesity and risk of new onset depressive symptoms in older adults: English Longitudinal Study of Ageing, International. Journal of Obesity. 2015:1-4.
36. Goncalves D, et al., . Functional capacity and obesity reflect the cognitive performance of older adults living in long-term care facilities. Psychogeriatric. 2017.
37. Barbosa J, et al., . Masa muscular, fuerza muscular y otros componentes de funcionalidad en adultos mayores institucionalizados de la Gran Caracas-Venezuela. Nutricion Hospitalaria. 2007.:578-83.
38. Di Monaco M, et al., . Handgrip strength is an independent predictor of distal radius bone mineral density in postmenopausal women. . Clinical Rheumatology. 2000;19(6).473-47.
39. Tapia C, Valdivia C, Varela Y, Carmona H , Iturra A, Jorquera V , et al. Indicadores de fragilidad en adultos mayores del sistema público de salud de la ciudad de Antofagasta. Revista médica de Chile. 2015;143:459-66.
40. Sasaki H, Kasagi F, Yamada M, Fujita S. Grip Strength Predicts Cause-Specific Mortality in Middle-Aged and Elderly Persons. The American Journal of Medicine. 2007;120(4):337-42.
41. Ostir G, et al., . Measures of lower body function and risk of mortality over 7 years of follow-up. American. Journal of Epidemiology. 2007;5.:599-605.
42. Lera L, Albala, Cecilia., Ángel, Bárbara, Sánchez., Hugo, Picrin., Yaisy, Hormazabal, María José., Quiero, Andrea.,. Predicción de la masa muscular apendicular esquelética basado en mediciones antropométricas en Adultos Mayores Chilenos. Nutrición Hospitalaria. 2014;29:611-7.
43. Lino V, Teresa, Saraiva Rodrigues., Nádia, Cristina, Pinheiro., O’Dwyer., Gisele, Andrade., Mônica, Kramer de Noronha Matto.,, Inês, Echenique Portela., Margareth Crisóstomo,. Handgrip Strength and Factors Associated in Poor Elderly Assisted at a Primary Care Unit in Rio de Janeiro, Brazil. PLoS ONE. 2016;11(11):e0166373.
44. Bohannon. R. Muscle strength: clinical and prognostic value of hand-grip dynamometry. Current Opinion in Clinical Nutrition & Metabolic Care. 2015;18(5):465-70.
45. Arroyo P, Lera, L., Sanchez, H., Bunout, D., Santos, J. L., & Albala, C. Anthropometry, body composition and
functional limitations in the elderly. Rev Med Chil,. 2007;135(7):846-54.
46. Seino. S, Yabushita., Noriko, Kim., Mi-ji Nemoto., Miyuki, Jung., Songee, Osuka., Yosuke, Okubo., Yoshiro, Figueroa., Rafael, Matsuo., Tomoaki, Tanaka., Kiyoji. Physical performance measures as a useful indicator of multiple geriatric syndromes in women aged 75 years and older. Geriatrics & Gerontology International. 2013;13(4):901-10.
47. Mancilla E, et al.,. Fuerza de prensión manual según edad, género y condición funcional en adultos mayores Chilenos entre 60 y 91 años. Revista Medica de Chile. 2016:598-603.
48. Ramírez-Campillo R, Castillo A, de la Fuente CI, Campos-Jara C, Andrade DC, Álvarez C, et al. High-speed resistance training is more effective than low-speed resistance training to increase functional capacity and muscle performance in older women. Experimental Gerontology. 2014;58:51-7.
49. Ramírez-Campillo R, Martínez C, Fuente CIdL, Cadore EL, Marques MC, Nakamura FY, et al. High-Speed Resistance Training in Older Women: The Role of Supervision. Journal of Aging and Physical Activity. 2017;25(1):1-9.
2. INE. Instituto Nacional de Estadística de Chile. Enfoque estadístico: Población adulta mayor en el bicentenario. Gobierno de Chile, Instituto Nacional de Estadística de Chile. Santiago, Chile.2010.
3. Albala C, Araya A, Barnett C, Borzuztku A, Bonout D, Castro S, et al. Situación demográfica en Chile. Manual Geriatría y Gerontología 2000.
4. Pérez V, Sierra F. Biología del envejecimiento. Revista médica de Chile. 2009;137:296-302.
5. SENAMA. Servicio Nacional de adulto mayor, Chile2011 [Available from: www.senama.cl/filesapp/cuentapublica2011.
6. Lopez J, Izquierdo, M., . Aspectos fisiológicos del ejercicio en relación al envejecimiento. In: Lopez J, Fernández, A., , editor. Fisiología del ejercicio. Madrid, España: Panamericana; 2006. p. 613-39.
7. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosisReport of the European Working Group on Sarcopenia in Older PeopleA. J. Cruz-Gentoft et al. Age and Ageing. 2010;39(4):412-23.
8. Delmonico MJ, Harris TB, Lee J-S, Visser M, Nevitt M, Kritchevsky SB, et al. Alternative Definitions of Sarcopenia, Lower Extremity Performance, and Functional Impairment with Aging in Older Men and Women. Journal of the American Geriatrics Society. 2007;55(5):769-74.
9. Goodpaster BH, Park SW, Harris TB, Kritchevsky SB, Nevitt M, Schwartz AV, et al. The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. The journals of gerontology Series A, Biological sciences and medical sciences. 2006;61(10):1059-64.
10. Peña G, Bustamante L , Ramírez M , Halley E , García L Evaluación de la ingesta proteica y la actividad física asociada con la sarcopenia del adulto mayor. Spanish Journal of Human
Nutrition and Dietetics. 2016;20(1):16 – 22.
11. García de Lorenzo y Mateos A, Álvarez J, De Man F. Envejecimiento y desnutrición: un reto para la sostenibilidad del SNS; conclusiones del IX Foro de Debate Abbott-SENPE. Nutrición Hospitalaria. 2012;27:1060-4.
12. Nieuwenhuizen WF, Weenen H, Rigby P, Hetherington MM. Older adults and patients in need of nutritional support: Review of current treatment options and factors influencing nutritional intake. Clinical Nutrition. 2010;29(2):160-9.
13. Janssen I, Heymsfield SB, Ross R. Low Relative Skeletal Muscle Mass (Sarcopenia) in Older Persons Is Associated with Functional Impairment and Physical Disability. Journal of the American Geriatrics Society. 2002;50(5):889-96.
14. Padilla C, Sánchez P, Cuevas M. Beneficios del entrenamiento de fuerza para la prevención y tratamiento de la sarcopenia. Nutrición Hospitalaria. 2014;29:979-88.
15. Lopez. J, Fernandez A. Fisiologia del Ejercicio. 3° ed. 3°, editor. Madrid, España: Editorial Panamericana; 2006.
16. Argilés JM, Busquets S, López-Soriano FJ, Figueras M. Fisiología de la sarcopenia: Similitudes y diferencias con la caquexia neoplásica. Nutrición Hospitalaria. 2006;21:38-45.
17. Feldman HA, Longcope C, Derby CA, Johannes CB, Araujo AB, Coviello AD, et al. Age Trends in the Level of Serum Testosterone and Other Hormones in Middle-Aged Men: Longitudinal Results from the Massachusetts Male Aging Study. The Journal of Clinical Endocrinology & Metabolism. 2002;87(2):589-98.
18. Adamo ML, Farrar RP. Resistance training, and IGF involvement in the maintenance of muscle mass during the aging process. Ageing Research Reviews. 2006;5(3):310-31.
19. Peake J, Gatta PD, Cameron-Smith D. Aging and its effects on inflammation in skeletal muscle at rest and following exercise-induced muscle injury. American Journal of Physiology - Regulatory, Integrative and Comparative Physiology. 2010;298(6):R1485-R95.
20. Laviano A, Meguid MM, Preziosa I, Fanelli FR. Oxidative stress and wasting in cancer. Current Opinion in Clinical Nutrition & Metabolic Care. 2007;10(4):449-56.
21. Evans WJ, Morley JE, Argilés J, Bales C, Baracos V, Guttridge D, et al. Cachexia: A new definition. Clinical Nutrition. 2008;27(6):793-9.
22. Lázaro M, et al.,. Nuevas tablas de fuerza de la mano para población adulta de Teruel. Nutrición Hospitalaria. 2008;23:35-40.
23. Choudhri A, Siddiqui A, Khan N, Cohen H. Understanding bibliometric
parameters and analysis. Radiographics : a review publication of the Radiological Society of North America. Inc. 2015;35(3).736-46.
24. Cramer JT, Cruz-Jentoft AJ, Landi F, Hickson M, Zamboni M, Pereira SL, et al. Impacts of High-Protein Oral Nutritional Supplements Among Malnourished Men and Women with Sarcopenia: A Multicenter, Randomized, Double-Blinded, Controlled Trial. Journal of the American Medical Directors Association. 2017;17(11):1044-55.
25. Rooks D, Praestgaard J, Hariry S, Laurent D, Petricoul O, Perry RG, et al. Treatment of Sarcopenia with Bimagrumab: Results from a Phase II, Randomized, Controlled, Proof-of-Concept Study. Journal of the American Geriatrics Society. 2017;65(9):1988-95.
26. Hassan BH, Hewitt J, Keogh JWL, Bermeo S, Duque G, Henwood TR. Impact of resistance training on sarcopenia in nursing care facilities: A pilot study. Geriatric Nursing.37(2):116-21.
27. Gariballa S, Alessa A. Sarcopenia: Prevalence and prognostic significance in hospitalized patients. Clinical Nutrition. 2013;32(5):772-6.
28. Di Monaco M, Castiglioni C, De Toma E, Gardin L, Giordano S, Di Monaco R, et al. Presarcopenia and sarcopenia in hip-fracture women: prevalence and association with ability to function in activities of daily living. Aging Clinical and Experimental Research. 2015;27(4):465-72.
29. Bischoff-Ferrari HA, Orav JE, Kanis JA, Rizzoli R, Schlögl M, Staehelin HB, et al. Comparative performance of current definitions of sarcopenia against the prospective incidence of falls among community-dwelling seniors age 65 and older. Osteoporosis International. 2015;26(12):2793-802.
30. Drey M, Sieber CC, Bertsch T, Bauer JM, Schmidmaier R. Osteosarcopenia is more than sarcopenia and osteopenia alone. Aging Clinical and Experimental Research. 2016;28(5):895-9.
31. Bjorkman MP, Suominen MH, Pitkälä KH, Finne-Soveri HU, Tilvis RS. Porvoo sarcopenia and nutrition trial: effects of protein supplementation on functional performance in home-dwelling sarcopenic older people - study protocol for a randomized controlled trial. Trials. 2013;14(1):387.
32. Malafarina V, Uriz-Otano F, Gil-Guerrero L, Iniesta R, Zulet MA, Martinez JA. Study protocol: High-protein nutritional intervention based on β-hydroxy-β-methylbutirate, vitamin D3 and calcium on obese and lean aged patients with hip fractures and sarcopenia. The HIPERPROT-GER study. Maturitas.76(2):123-8.
33. Laurentani F, Russo, C., Bandinelli, S., et al. Age-associated changes in skeletal muscles and their effect
on mobility: an operational diagnosis of sarcopenia. J Appl Physiol. 2003;95:1851-60.
34. Lenardt M, Binotto M, Hammerschmidt N, Cechinel C, Betiolli S, Lourenc T. Handgrip strength and physical activity in frail elderly. Da escola de Enfermagem Da USP. 2016;50(1):86-92.
35. Hamer M, et al., . Sarcopenic obesity and risk of new onset depressive symptoms in older adults: English Longitudinal Study of Ageing, International. Journal of Obesity. 2015:1-4.
36. Goncalves D, et al., . Functional capacity and obesity reflect the cognitive performance of older adults living in long-term care facilities. Psychogeriatric. 2017.
37. Barbosa J, et al., . Masa muscular, fuerza muscular y otros componentes de funcionalidad en adultos mayores institucionalizados de la Gran Caracas-Venezuela. Nutricion Hospitalaria. 2007.:578-83.
38. Di Monaco M, et al., . Handgrip strength is an independent predictor of distal radius bone mineral density in postmenopausal women. . Clinical Rheumatology. 2000;19(6).473-47.
39. Tapia C, Valdivia C, Varela Y, Carmona H , Iturra A, Jorquera V , et al. Indicadores de fragilidad en adultos mayores del sistema público de salud de la ciudad de Antofagasta. Revista médica de Chile. 2015;143:459-66.
40. Sasaki H, Kasagi F, Yamada M, Fujita S. Grip Strength Predicts Cause-Specific Mortality in Middle-Aged and Elderly Persons. The American Journal of Medicine. 2007;120(4):337-42.
41. Ostir G, et al., . Measures of lower body function and risk of mortality over 7 years of follow-up. American. Journal of Epidemiology. 2007;5.:599-605.
42. Lera L, Albala, Cecilia., Ángel, Bárbara, Sánchez., Hugo, Picrin., Yaisy, Hormazabal, María José., Quiero, Andrea.,. Predicción de la masa muscular apendicular esquelética basado en mediciones antropométricas en Adultos Mayores Chilenos. Nutrición Hospitalaria. 2014;29:611-7.
43. Lino V, Teresa, Saraiva Rodrigues., Nádia, Cristina, Pinheiro., O’Dwyer., Gisele, Andrade., Mônica, Kramer de Noronha Matto.,, Inês, Echenique Portela., Margareth Crisóstomo,. Handgrip Strength and Factors Associated in Poor Elderly Assisted at a Primary Care Unit in Rio de Janeiro, Brazil. PLoS ONE. 2016;11(11):e0166373.
44. Bohannon. R. Muscle strength: clinical and prognostic value of hand-grip dynamometry. Current Opinion in Clinical Nutrition & Metabolic Care. 2015;18(5):465-70.
45. Arroyo P, Lera, L., Sanchez, H., Bunout, D., Santos, J. L., & Albala, C. Anthropometry, body composition and
functional limitations in the elderly. Rev Med Chil,. 2007;135(7):846-54.
46. Seino. S, Yabushita., Noriko, Kim., Mi-ji Nemoto., Miyuki, Jung., Songee, Osuka., Yosuke, Okubo., Yoshiro, Figueroa., Rafael, Matsuo., Tomoaki, Tanaka., Kiyoji. Physical performance measures as a useful indicator of multiple geriatric syndromes in women aged 75 years and older. Geriatrics & Gerontology International. 2013;13(4):901-10.
47. Mancilla E, et al.,. Fuerza de prensión manual según edad, género y condición funcional en adultos mayores Chilenos entre 60 y 91 años. Revista Medica de Chile. 2016:598-603.
48. Ramírez-Campillo R, Castillo A, de la Fuente CI, Campos-Jara C, Andrade DC, Álvarez C, et al. High-speed resistance training is more effective than low-speed resistance training to increase functional capacity and muscle performance in older women. Experimental Gerontology. 2014;58:51-7.
49. Ramírez-Campillo R, Martínez C, Fuente CIdL, Cadore EL, Marques MC, Nakamura FY, et al. High-Speed Resistance Training in Older Women: The Role of Supervision. Journal of Aging and Physical Activity. 2017;25(1):1-9.
Publicado
2017-07-31
Cómo citar
Hernández-Martinez, J., & Ramirez-Campillo, R. (2017, julio 31). PREDICCIÓN DE SARCOPENIA MEDIANTE LA FUERZA DE AGARRE DE MANO EN ADULTOS MAYORES. Revista Horizonte Ciencias De La Actividad Física, 8(1), 27-36. Recuperado a partir de http://revistahorizonte.ulagos.cl/index.php/horizonte/article/view/7
Sección
CIENCIAS DEL EJERCICIO PARA LA SALUD / EXERCISE SCIENCES FOR HEALTH
