Adattamenti muscolari

all’invecchiamento e ai
fenomeni
osteodegenerativi
Marsilio Saccavini
UOC Degenza di Medicina Riabilitativa
TREVISO
 Lean body mass
• Main sites of loss: muscle, liver, kidneys,
adrenal glands, brain
• General population shows ~constant LBM
up to 4th decade and a decline thereafter.
• By 8th decade, men show a 40% loss, women
a 20% loss of young adult LBM
• Decline in IGF-1, testosterone, insulin level,
and physical activity, are associated with
LBM reduction
 Loss of Muscle Strength and Power
• At the age of 70-79 yrs, quadriceps force is
~60% of that at 20-29 yrs. Relative force loss is
similar for both gender.
• The loss of muscle power seem to be greater
than that of force. From 65 to 84 yrs, force is
lost at a rate of 1.5%/yr, power at a rate of
3.5%/year (Young & Skelton 1994)
• Leg extension muscle power is correlated with
speed or raising from a chair, stair climbing test
& speed of walking (Bassey et al. 1992)
Skeletal muscle strength
Decline in motor unit number
 Loss of Strength and Power in old age
180 180

160 160

140 140

120 120 Torque YOUNG

Torque OLD
100 100
Power YOUNG
Power OLD
80 80
Series5
60 60 Series6

40 40

20 20

0 0
0 1 2 3 4 5 6

Angular velocity (rad/s)

Absence of muscle weakness in
eccentric contractions
 Causes of force loss
• Muscle fibre atrophy, particularly of type II
• Decrease in fibre number
– SARCOPENIA
• Decrease in neural drive (voluntary contractions)
• Decrease in the force per cross-sectional
area of each muscle fibre
Fibre number and ageing
Sprouting
Muscle twitch
Decreased fusion frequency
Resistance to fatigue
 Frailty
• “A state of reduced physiological reserves
associated with increased susceptibility to
disability” (Buchner and Wagner, Clin. Geriatr. Med.
7, 1992)
• Frailty is characterised by generalised
weakness, impaired mobility and balance
and poor endurance.
 Muscle strength with age

Act
60 iv e Pe
rson

Muscle 40 Sed
enta
Strength r yP
e rs o Training
Kg n
20
Independence
Threshold

20 40 60 80
Age (years)
 Can frailty be prevented by
physical activity ?

Effects of:
• Low-intensity, long duration exercise
• High-intensity, short duration exercise
Effects of endurance training on
muscle strength of elderly men
PHYSICAL ACTIVITY IN OLD AGE

Strength training has

repeatedly been shown to be
a safe and effective
intervention to mitigate
muscle weakness and
sarcopenia.

Improves mobility and

reduces incidence of falls
(Tracy et al. 1994).
 Holistic type of training is recommended

Tai Chi shown to be effective

falls prevention exercise in over
65’s with poor strength and
balance.
Improves postural stability and
muscle strength reducing risk of
falls.
Also proven to be beneficial to:
cardiorespiratory function,
flexibility and
balance control
(Wolf et al. 1993).
 Protocol
METHODS
Training Program:
3x wk: 2 supervised, 1 home
based session. Approx. 1hr.
• 10min warm up and stretch
• Aerobics exercise
• Strengthening exercises: 6
machines and therabands
• 10min cool down - Tai Chi.
 Adaptations to training
• Structural adaptations
• Contractile adaptations
• Neural adaptations
• Performance adaptations
 Structural adaptations
• Muscle hypertrophy
• Fibre hypertrophy
• Fibre distribution
 Muscle hypertrophy
Age Muscle Duratn ∆ CSA Reference
(yrs) (wks) (%)
86-96 Knee 8 9.0 Fiatarone et al.
ext. JAMA 13, 1990

85-97 Knee 12 9.8 Harridge et al.

ext. Muscle&Nerve 22, 1999

60-72 Knee 12 9.3 Frontera et al.

ext. JAP 64, 1998

57-65 Knee 10 8.5 Häkkinen et al.

ext. J Gerontol 53A, 1998
Fibre hypertrophy
 Muscle fibre distribution
• No significant changes in type I/type II
fibre proportion
• Distribution of type I fibre unaffected
• Type II fibre subtypes show changes similar
to those of young adults:
– Type IIa proportion decreases
– Type IIab proportion increases
– Type IIb proportion decreases
Fibre transformations
Training-induced fibre transformations
in young adults
 Contractile adaptations
• Maximum weight lifting ability: increases
• Isometric MVC: increases
• Maximum power: increases
• Twitch characteristics: TPT, unchanged,
1/2RT increases (?)
• Work sustainable: increases
1-RM of knee extensors & flexors
Isokinetic Torque & Power

250 400

200
300

150
200
100

100
50

0 0
0 5 10 15
-1
Angular velocity (rad.s )
Total work performed during
25 reps at 240º/s

1500

+41%
1000

500

0
Before After

From: Roman et al. J Appl Physiol 74, 1993

 Neural changes
• Muscle activation capacity
• Maximum EMG activity
• Antagonist muscle co-activation
Muscle Activation Capacity
Maximum EMG activity
 Gains in strength and size:
elderly and young compared
Population training Strength gain/day Authors
duration gain (%) (%)
Elderly 16 wks 21.9 0.19 Narici et al.
(65-81 yrs) 2000

Elderly 12 wks 16.7 0.20 Frontera et al.

(60-72 yrs) 1988
Elderly 12 wks 37.0 0.44 Harridge et al.
(85-97 yrs) 1999
Young 24 wks 26.8 0.16 Hakkinen et al.
adults 1985
Young 12 wks 15.0 0.18 Rutherford
adults et al. 1987
Young 24 wks 29.6 0.18 Narici et al.
adults 1996
Strength is correlated with
performance
Effect of ageing on
myosin molecule
speed