Enhancing Muscle Strength in Older Adults: Key Facts and Guidelines

1. Exercise in older people Dr Richard A. Ferguson Musculo-Skeletal Muscle Biology Research Group School of Sport, Exercise and Health Sciences Loughborough University

2. “The biggest issue is loss of function. Not everyone has cancer, not everyone has Alzheimer's, but almost everyone loses function”. David Muller Dean of Medical Education Mount Sinai School of Medicine in New York City

3. The background issues … • Skeletal musclefunction • Aerobic function

4. THE BIG QUESTIONS

5. THE BIG QUESTIONS

6. THE BIG QUESTIONS

7. THE BIG QUESTIONS

8. THE BIG QUESTIONS

9. THE BIG QUESTIONS

10. Resistance / strength exercise Age range 60 – 72 yrs 80% 1-RM (progressive) 3 sets of 8 reps 3 days per week for 12 weeks Frontera et al (1988)

11. Resistance / strength exercise • Even in VERY old people Age range 85 – 97 yrs 80% 1-RM (progressive) 3 sets of 8 reps 3 days per week for 12 weeks Harridge et al (1999)

12. Resistance / strength exercise • Even in VERY old people Age range 85 – 97 yrs 80% 1-RM (progressive) 3 sets of 8 reps 3 days per week for 12 weeks Harridge et al (1999)

13. UK Physical Activity Guidelines

14. UK Physical Activity Guidelines

15. UK Physical Activity Guidelines Older adults should also undertake physical activity to improve muscle strength on at least two days a week.

16. Effects of strength training on physical function

17. Physical function – systematic reviews “…. resistance training increased muscle strength and had a modest significant effect on some measures of physical functioning (e.g., gait speed)”.

18. Physical function – systematic reviews “Evidence shows that older people who exercise their muscles against a force or resistance become stronger. They also improve their performance of simple activities such as walking, climbing steps, or standing up from a chair more quickly. The improvement in activities such as getting out of a chair or stair climbing is generally greater than walking speed” Liu & Latham (2009)

19. Physical function – systematic reviews “Evidence shows that older people who exercise their muscles against a force or resistance become stronger. They also improve their performance of simple activities such as walking, climbing steps, or standing up from a chair more quickly. The improvement in activities such as getting out of a chair or stair climbing is generally greater than walking speed” Liu & Latham (2009)

20. Alternative interventions

21. Alternative interventions • Muscle power = force x velocity Narici et al. (2005)

22. Alternative interventions • Traditional resistance training velocity Narici et al. (2005)

23. Alternative interventions • High velocity resistance training Narici et al. (2005)

24. InVEST – Increased Velocity Exercise Specific to Task Age ~74 yrs 3 days per week for 16 weeks NIA – National Institute of Aging strength training program (2 sets of 10) concentric phase performed slowly (3 sec) InVEST – task specific movement pattern concentric phase performed as quickly as possible SPPB – short physical performance battery Bean et al (2009)

25. InVEST – Increased Velocity Exercise Specific to Task Bean et al (2009)

26. InVEST – Increased Velocity Exercise Specific to Task Bean et al (2009)

28. “human muscle age-related molecular processes appear distinct from the processes directly regulated by those of physical activity”

30. Marr explained he had fallen into the "terrible" trap of believing what he read in newspapers, which encouraged people to "take very intensive exercise in short bursts - and that's the way to health". He went on: "I went onto a rowing machine and gave it everything I had, and had a strange feeling afterwards - a blinding headache, and flashes of light - served out the family meal, went to bed, woke up the next morning lying on the floor unable to move.

31. Summary • Resistance training into later life attenuates the decline in muscle strength • Does not necessarily enhance functional ability RESEARCH FUNDING OPPORTUNITIES ;-) • Large variability in “responsiveness” to exercise interventions • Exercise for older people should be personalised (baseline physiology / genetic screening!!) • RESEARCH FUNDING OPPORTUNITIES ;-)

32. THANK YOU R.Ferguson@lboro.ac.uk http://twitter.com/ncsemem