Aging and the effects of exercise on muscle mass and function

Stephen P. Sayers, PhD, Department of Physical Therapy, University of Missouri

Outline
I. Changes in Muscle Mass with Aging
Sarcopenia

II. Changes in Muscle Performance with Aging Strength, Power III. Factors Responsible for Age-Related Changes in Muscle Mass and Function IV. Does Exercise Restore Muscle Mass and Function?

Changes in Muscle Mass with Aging

40% loss in muscle mass from 20-70 years of age
Rogers & Evans, 1993

6% decline in muscle mass per decade from age 30-70

Fleg & Lakatta, 1988

1.4 2.5% decline in muscle mass per year after age 60

Frontera et al., 2000

Changes in Muscle Mass with Aging

Lexell et al., 1988

Sarcopenia
age-associated decline in muscle mass

Sarco flesh (muscle). penia deficiency. Sarcopenia is associated with increased mortality and functional decline
Roubenoff, 2003

Sarcopenia
age-associated decline in muscle mass

21 year old Female (BMI = 24.3 kg/m2)

73 year old Female (BMI = 24.5 kg/m2)

Sarcopenia
Muscle Fiber Changes with Aging: 1) Decreased muscle fiber size (atrophy) 2) Decreased number of muscle fibers

Sarcopenia
Muscle Fiber Changes with Aging: 1) Atrophy Men: 20-29 and 60-65 Type I - no change Type II - 25% decrease
Larsson et al., 1978

Men: 19-84 Type I - 6% decrease Type II - 35% decrease

Lexell, 1991

Sarcopenia
Muscle Fiber Changes with Aging: 1) Atrophy By age 85, Type II fiber CSA may be less than 50% of that for Type I fibers

Type I

Type II

Sarcopenia
Muscle Fiber Changes with Aging: 1) Atrophy Maintenance of Type I fiber size may be compensatory hypertrophy
Lexell, 1991

Disuse of Type II fibers?

Sarcopenia
Muscle Fiber Changes with Aging: 2) Decreased number of fibers 25% loss in men ages 19-37 to 70-73
(110,000 difference)
Lexell et al., 1983

Muscle of 20 yr old - 70% fibers Muscle of 80 yr old - 50% fibers

Lexell et al., 1988

Sarcopenia
Muscle Fiber Changes with Aging: 2) Decreased number of fibers Selective loss of Type II fibers:

Type I fiber % increased from 40 to 55 in men ages 20-30 and 60-65

Larsson, 1982

Loss of Type II fibers? Acquiring more Type I fibers?

Sarcopenia
No single feature of age-related decline can more dramatically affect nutritional status, ambulation, mobility, and functional independence.*
*Rosenberg 1989

Prevalence (%) of Sarcopenia*

Age group
(years)

Males
(n=205)

Females
(n=173)

<70 70 74 75 80 >80

13.5 19.8 26.7 52.6

23.1 33.3 35.9 43.2

*New Mexico Elder Health Survey, Baumgartner et al. 1998

II. Changes in Muscle Performance with Aging

Muscle Strength
Maximum capacity to generate force or tension.
Muscle CSA Intrinsic factors MU recruitment / Firing rate

Upper extremity strength

120 100 80

% of 20 yr old group

60 40 20 0 25 35 45 55 65 75 85

Strength

Age

Metter et al., 1997 J. Gerontol.

Strength Loss with Aging

8% loss per decade after age 45 Brooks, 1995

Strength increases up to age 30 Plateaus from age 30 50

Declines 24-36% between 50-70

Larsson, 1979

# women unable to life 4.5 kg (10 lbs) increased from 40% in 55-64 yr olds to 65% in those age 75-84.
Jette & Branch, 1981

Strength Loss with Aging

Most precipitous loss after age 70:

35% loss over 11 year period in 80 year old subjects

Grabiner & Enoka 1995

15% loss per decade up to 6th and 7th decades of life, 30% loss per decade thereafter Evans, 1997

Strength loss does not always parallel loss in muscle mass

Specific Strength (Force per CSA) may be lower in older compared to younger men
Quadriceps CSA decreased 21% (65-80) Force production decreased 39%
Jubrias et al. (1997)

Quantitative and qualitative changes

Muscle Power
Power: Maximum rate of work
performance Power = Force x Velocity

Power vs. strength over time

120 100 80

% of 20 yr 60 old group
40 20 0 25 35 45 55 65 75 85

Strength Power

Age

Metter et al., 1997 J. Gerontol.

Muscle Power
Men and women in their 70s compared to 20s:
Vertical Jump Force 50% lower Vertical Jump Power 70-75% lower

Bosco & Komi, 1980

Strength loss 1-2% per year after 60 Power loss is ~3.5% per year
Skelton et al., 1994

How do changes in strength and power impact function?

*Diminished reserve capacity
100 90 80 Percentage of 70 Maximum 60 50 voluntary contraction 40 30 (MVC) 20 10 0 25 years 75 years

% MVC/Power needed to perform ADLs

MVC

III. Factors Responsible for Age-Related Changes in Muscle Mass and Function

Sarcopenia*
age-associated decline in muscle mass

etiology related to changes in:

hormone status neural factors Inflammation
Age-related

protein/energy intake disuse atrophy

*Rosenberg 1989

Behavioral

Sarcopenia

Roubenoff, 2003

What factors are responsible for decreased strength in older men and women?
1. Changes in force producing capability of muscle tissue

2. Changes in neural activation of muscles

1.Changes in force producing capabilities of muscle

1.Decrease In Specific Tension of Individual Fibers 2. Relative Increase in Type I Fiber Characteristics Death of motor neurons (spinal cord)
Death of Some Muscle Fibers

-Multiple MHC isoforms (hormones)

3. Muscle Atrophy
Barry & Carson, J Gerontol 2004

-Re-innervation of Some fibers -Motor Unit Remodeling

(Fewer, larger MUs)

2. Changes in neural activation of muscles

The ability to develop maximal force is dependent upon the capacity of the nervous system to maximally activate individual muscles, and to coordinate appropriately the activation of groups of muscles.
Barry & Carson, J Gerontol 2004

2. Changes in neural activation of muscles

1.Inability to maximally activate individual muscles 2. Inability to coordinate groups of muscles

Reduced cortical drive Altered motor neuron excitability

Increased co-activation of agonist/antagonist Increased antagonist activation

NMJ Degradation Impaired E-C Coupling

Reduces net maximal joint torque Limits rate of force development

Barry & Carson, J Gerontol 2004

Distrupted agonist/synergist activation

Factors responsible for decreases in power

Skeletal muscle mass Sarcopenia Neural Factors

Fiber number, Cross-sectional area, Selective type II atrophy Larsson, 1979

Loss of Motor units (47% decrease 20-65)

Doherty, 1993

MU remodeling (Type I) Specific tension, in vitro shortening velocity

Larsson, 1997

Contraction velocity: E-C coupling impairment SR impairment Actin slowing (18-25%)

Reduced MU firing rates, Asynchronous MU firing, Slowed nerve CV

IV. Does Exercise Restore Muscle Mass and Function?

Muscle and Neural Adaptations with Resistance Training

Resistance Training in Older Adults

Landmark RT Studies:
Moritani & DeVries (1980) Aniansson et al. (1980)

First studies to demonstrate safety and potential for increases in strength in older men
Little hypertrophy response

Resistance Training in Older Adults

Landmark Studies:
Resistance training and strength: Men 60-72 (12 weeks): 107-226% increase
Frontera et al., 1988

Women 64-86 (12 weeks): 28-115% increase

Charette et al., 1991

Men & Women 86-96 (8 weeks): 174% increase

Fiatarone et al., 1990

Resistance Training in Older Adults

Landmark Studies
Resistance training and hypertrophy:
Men 60-72 (12 weeks): Type I 33.5% increase Type II 27.6% increase Frontera et al., 1988 Women 64-86 (12 weeks): Type I 7.3% increase (NS) Type II 20% increase Charette et a., 1991 Men & Women 86-96 (8 weeks): Muscle CSA (8.4-11%) Fiatarone et al., 1990

Resistance Training in Older Adults

Power Training in Older Adults

Fielding et al. (2002) Power training in older women (N=25; Age = 73.2
years)

Power Training: Strength Training:

High-intensity high velocity RT High-intensity low velocity RT

LP and KE: 3 x 8, 3x/wk, 16-wks @ 70% 1RM

The Disablement Pathway

(Nagi, 1965; Verbrugge & Jette, 1994)

Pathology
Impairment Strength Power

?
Functional Limitation

?
Disability

Resistance Training in Older Adults

Effects on Function and Disability are Questionable:

Latham et al., 2003

Small to moderate effect on Function Little to no effect on Physical Disability

Functional Threshold
Threshold Healthy Elderly

Motor Impaired Pre-Frail

Functionally Limited (Frail)

Function Strength/Power

The Disablement Pathway

(Nagi, 1965; Verbrugge & Jette, 1994)

Pathology
Impairment Correcting strength impairments has been primary focus Functional Limitation Disability

What about other impairments?

Muscle Power
Maximum rate of work performance

Power = F x V
Key component of success in athletics

Is Muscle Power and Contraction Velocity Important in Older Adults?

Muscle Power and Function

Studies have shown that lower extremity muscle power is a stronger predictor of functional limitations and disability than muscle strength in older men and women
Bean et al., 2002; Suzuki et al., 2001; Foldvari et al., 2000

Muscle power declines sooner and more rapidly than strength

The Disablement Pathway

(Nagi, 1965; Verbrugge & Jette, 1994)

Pathology
Impairment Functional Limitation Disability

*Power may be a more critical variable on which to focus resistance training protocols

Low and High Velocity Power and Function

Physical Performance Stair Climb (n=45) 1RM strength Leg Power* 70% 1RM 40% 1RM Chair Rise (n=45) 1RM strength Leg Power* 70% 1RM 40% 1RM Coefficient Standard Error R2 p-value

-0.270 -0.206 -0.169

0.12 0.071 0.06

0.32 0.43 0.42

0.027 0.000 0.000

-0.301 -0.152 -0.154

0.10 0.070 0.057

0.31 0.24 0.28

0.005 0.024 0.009

Muscle power at high or low velocity may be more important to certain functional tasks than muscle strength Speed at which we generate power is critical to lower intensity functional tasks

Habitual Gait (n=45) 1RM strength Leg Power* 70% 1RM 40% 1RM

0.296 0.223 0.214

0.08 0.049 0.037

0.40 0.51 0.59

0.001 0.000 0.000

*adjusted for age, body mass, and gender

Cuoco A, Callahan DM, Sayers SP, et al. J. Am. Geriatr. Soc. 2004

Contraction Velocity and Function

________________________________________________________________________ Function Standardized p-value Partial F Partial R2 VIF

Gait Speed over 400 m Model R2=0.32 (p<0.001) Velocity (m/s) 0.483 Leg Strength (N) 0.296 Sex -0.247
2

ALL; n=101 <0.001 0.005 0.020 24.5 8.18 5.61 0.18 0.06 0.04 1.304 1.471 1.494

Women; n=64 <0.001 17.8 0.24 1.000

Model R =0.24 (p<0.001) Velocity (m/s) 0.485 Leg Strength (N)*

2

Men; n=37 0.005 0.016 9.03 6.49 0.16 0.12 1.087 1.087

Model R =0.39 (p<0.001) Velocity (m/s) 0.420 Leg Strength (N) 0.356

Contraction velocity alone was more important to walking speed than muscle strength in older adults

Sayers SP, et al. J. Am. Geriatr. Soc. 2005

The Disablement Pathway

(Nagi, 1965; Verbrugge & Jette, 1994)

Pathology
Impairment Functional Limitation Disability

*Contraction velocity (speed) may also be a critical variable on which to focus resistance training protocols

Current Study - Sayers

53 (12 currently) older men and women > 65 years of age will perform 12 weeks of RT 3x/week Velocity Training: 3 x 14 @40% 1RM "as fast as possible" Strength Training: 3 x 8 @80% 1RM over 2 seconds Control Functional Tasks: Stair Climb, Chair rise, Timed Up and
Go, Balance, Short and long walking tasks

Preliminary Conclusions
Muscle strength and power both appear to be improved with velocity training
Some functional tasks appear to be improved by training at lower resistances and higher speeds Too soon to tell