Sarcopenia, mobility and balance: the importance of physical exercise

Book Chapter

Reference

Sarcopenia, mobility and balance: the importance of physical exercise

RIZZOLI, René, HARS, Melany

RIZZOLI, René, HARS, Melany. Sarcopenia, mobility and balance: the importance of physical exercise. In: Sarcopenia . Paris : Springer Science + Business Media France Sarl, 2013. p.

184-191

Available at:

http://archive-ouverte.unige.ch/unige:33227

Disclaimer: layout of this document may differ from the published version.

Sarcopenia La Sarcopdnie

O iOtl iprirrge, Science * Business Media France Sarl. Tous droits r6serv6s

Sarcopenia' mobility and balance:

the importance of physical exercise

柵 臨‰

muscle lnass.This deiciency is the result

ml獄 鮒

態器 肥 珈 ¶糞鰍 獄 癬 機   ^職盤出

prevention and tteament,physicd exerciま and to a lesser extent,musCle rnass.

EXERCISE AND PHYSICALACTIVITY

repetit市e,and purposefu with the alll1 0fimproving or malntaining phySiCal ntness or mctioning.

Moderate''physical act市 ity is distinguished hm intense"or̀̀vigorous"physical

a¶ 翼額

^e dso v面ous types of exerdsQ Endurttce or ^aerobに"exerdseお a

l露

Ⅷ 鶴躙 棚難獄 :肥 獄 淵 脚 鷺 艦

Iǹ̀resistance"aCt市ides,musCles must wOrk agamst a fOrce Such as a count計

鵬

^ight

Or elastic bandso Small numbers of repetitions of these exercises tte undertaken in a short space of tilne.̀̀Stretching"exercises,such as yoga,involve muscle and

鮮曜 朧躙捕綴難鮮聯議鐵

to unprove balance。

184

B 725b

Sarcopenia, mobility and balance: the importance of physical exercise

IMPACTS OF PITYSICAL EXERCISE

Physical exercise exerts an influence on all the body's systems: on muscle, of course, but also on the heart, the brain, and hormone secretions. Insufficient physical exer- cise may lead to organ failure [1].

The primary objective

of

physical exercise

is to

improve muscle strength and power, i.e. the strength that can be deployed per

unit of

time. Different types

of

exercise develop one or both.

Physical exercise also aims

to

improve physical performance as measured by various tasks such as the gait speed test, the short physical performance battery, the stair climb power test, the 6-minute walking test, and the timed get-up-and-go test (TUG), etc.

These tasks measure muscle strength and power. They are

of

interest because

of their

capacrty

to

reveal changes

in

muscle function earlier than the measure

of

muscle mass alone. Numerous studies have shown that the age-related loss

of

strength and power is more pronounced than the loss of muscle mass. Thus, the US 3-year longitudinal Health, Aging and Body Composition Study

of

1880 subjects

with

an average age

of

73 years showed that up

to

12Yo of muscle strength could be lost, for a loss of mass of just 7Yo or so (see

fig.

1) [2]. This study also showed that the age-related loss of power is even more pronounced than the loss of muscle shength [3].

Lean mass strength

Women Lean

mass

^strength

︵Ｓ︶ｏ編も紹０日２嘔８口長０

2 0

‑2

‑4

‑6

‑8

‑10

‑12

‑14

‑16

・・・‐ U・

・・・ ‐・・・・ ‐・ ‐‐‐・・ ‐‐・ ‐・

pく.001       pく。301       pく。001       pく.016

□wetht bserぃ%)国staЫe wdgh■ Wetht gaherぃ%)

Renb Rizzoli, MelanY Hars

Changes in muscle mass and strength were determined in 1880 elderly individuals' Knee extensor strength was measured using isokinetic dynamometry' Lean ^maSS was measuredusing dual-energy absorptiometry ^and computer-assistedtomography.

Muscle ^{strength dJcreased much}

*or.

^rapidly than the concomitant loss of muscle mass.

WIIAT

IS

THE EVIDENCE FORTI{E BENEFICIAL EFFECT

OF EXERCISE?

A widely

^{accepted dogma considers} that physical ^exercise and activity are ^good for bones, muscle and various organr

rorh

as the heart. HoweveE well-conducted studies do not always manage

to

show these benefits clearly

in

the elderly. ^Some of these studies showed thairesistance exercise produced similar improvements

in

muscle mass and strength

in

both young and elderly ^subjects, while others show better results in the younger group.

Ultimately, ameti-analysis of tlese ^studies by Cochrane identified ^a difference

of

just L4%betrveen the groups that had followed a physical exercise programme and the control ^grouPs.

The

heterog.*o.s

nature of the studies and their content has led to uncertainty re- garding the degree of evidence that supports the beneficial eflect of physical ^exercise on muscle strength ^{and mass:}

-

cross-sectionai

or

longitudinal observational studies,

or

controlled intervention studies;

-

type of intervention or independent variable;

-

population (normal or sarcopenic);

-

^{age at} intervention;

-

^duration of intervention, reversibility of the effect ^measured;

-

compliance;

-

variable studied (muscle mass, strength and power,

or walking

speed

or

falls, which may also involve coordination ^or

balance); .

^..,

-

^{presence of} confoundingvariables (nutrition,hormonal status ortgeapment, obesity,

social eondition, cognitive function,,osteoarticular damage or metabolic changes).

Thus, the duration ofrandomized controlled ^{tests varies} from 10 weeks to 18 months for groups of 23

-246

^subjects.

A

variety of ^{exercises a"re used.} The development

of

*"if.

parameters after the ^end ofthe intervention ^is rarely quantified or documented.

DEMONSTRATED

EXAMPLES OFA BENEFICIAL ^EFFECT

A

variety

of

initiatives have, however, revealed a clear benefit

to

elderly and even

very

elderly people

following

a physical training programme. For example, ^thp

186

Sarcopenia, mobility and balance: the importance of physicat exercise

Fiatarone study, which led the way in this

field

included 100 subjects who undertook 45 minutes of lower limb resistance exercise each day in association with nuhitional supplements. Significant difficulties of implementation were experienced in respect of this study, given aL average age of 87 years for study subjects (who ranged

fto*

72to 98 years), with a follow-up period of 10 weeks. Ninety-fourpatients completed the study. Their muscle strength had almost doubled walking speed had increased by almost

I0%

and power as assessed by the stair climbing test had risen

by

24%

(see fig. 2)

l4l.

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200 77s 1s0 t25 100 75 s0 25 0 -25

15

-50

-100

Exercise Exercise

*

Supplement Control supplement

Study G

Figure 2. Average increase in muscle strength firther to an exercise programme and nutritional sup- plements [4].

The bar chart shows the average change in the strength oftrainedmuscles compared with ^the value on inclusion. The impact of exercise was significant after adjustment for age, gender, firnctional status, muscle strength on inclusion and hypertension.

A

further study of a small number of subjects (active treatment: 11

:

1

l;

controls:

n:

12) aged between 85 and 97 yearc examined the impact

of

l2weeks of progres- sive resistance exercise. Training sessions increased isometric knee extensor strength by 37% and isokinetic knee strength by

4I -

47%. Biopsies showed hypertrophyof fast-twitch, type

II

muscle fibres, while there appeared to be less

of

an impact on slow-twitch, type

I

muscle fibres [5].

Finally, it would seem that functional performance and incap acity are more closely associated

with

muscle power than

with

muscle shength. Fast resistance training improves muscle power and functional development more effectively than slow

Rend Rizzoli, M6'lanY Hars

DO

THE

BENEFITS

TOYOI]NG

AND

ELDERLY

SUBJECTS DIFFER?

why

^{do physical training} progralnmes appear to provide ^less of ^{a benefit} to elderly subjects than to Younger subjects?

The decrease in prot""in synifresis with increasing ^age is apr,lmary factor in decreased effectiveness. The comparison of muscle protein synthesis in re.sponse to physical exercise shows the existence of anabolic

r"rirtuttte

in elderly patients

t6]' Similarh it

has been shown that

for

the same quantity

of

orally administered amino ^acids, elderly people

will

show reduced rrryonutitlar protein ^synthesis in comparison

with

young peoPle (see fig. 3) t7l.

The patient's

conditio'

^ut the start of ^a physical ^exercise progralnme also ^appears to have an impact. A ^study

of

lgg frail ^subjects

with

^{anaverage age of 75 years, who} had taken part

in

a 6-month home-basei physiotherapy programme, ^showed that subjects

*ith

^moderate

^frailty

benefited from the programme while there was no effect for severely frail subjecis ^(see fig. 4) tsl. It ^{therefore seems} unrealistic ^to hope that very frail ^patients

wili

derive benent from ^a physiothtlupy programme'

if

only becausethey may not be ^capable of performing ^{the required exercises'}

A third factor ihat ^reduces effectiveness is diet. Only when subjects consume more than 1.1 g of protein ^per kilogram of body mass is the beneflt of ^a physiotherapy pro-

gr*.-*ident

ⁱⁿ

^{tirms of}

an increase

in

lean mass, measured using dual-energy abso*itiometry.

It

is therefore important that ^subjects' diet is ^adequate in order

for

the effect of physiotherapy to be detected

[9]'

Myoibrinar prOtein FSR(%。^h‐1)

0.12

.+

^young

**   **

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:   ^鸞懸

188

Sarcopenia, mobility and balance: the importance of physical exercise

A Overa■ B Participants with

Moderate Frailty

C Participants with

Severe Frailty

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X'igure 4. Average incapacity at baseline and after 3,7 a;oLd 12 months of a physiotherapy programme in moderately or severely frail patients [8]. ^Results in the treatrnent and control groups are reported as average incapacity scores. Negative binomial models were used to calculate the results, adjusted for the means of recruifinent ^(based on consultation or records), physical frailty (graph A only) and the incapacity score on inclusion.

RECOMMENDATIONS FOR

THE ELDERLY

Various orgafizations have issued recommendations for the elderly. For example, the American College

of

Sports Medicine and the American Heart Association recom- mend 30

-

40 minutes of moderate aerobic physical exercise or 20

-

30 minutes

of

vigorous exercise each day, plus strength exercises such as getting out of a chair and flexibility exercises on at least 2 days every week. Balance exercises are recommended if the patient is at risk of a fall ^or has already hadanumber of falls. It is acknowledged that it.is no straightforward matter to advise this type of training programme to the over 80s sufficiently convincingly to secure their long-term adherence, and that there are questions regarding the feasibility of following such recommendations.

Music-based multitask ^exercises

However, there is a need for effective sfategies to prevent sarcopenia in elderly patients.

"Jaques Dalqoze" eurhythmics may be an interesting alternative. This

is

a musical education method developed in Geneva at the start of thez}thcentury, based on music, movement and improvisation. It consists of dissociated movements of the lower and up- per limbs, performed in time to improvised piano music. It engages the elderly individual in a new form ofphysical exercise, which promotes a strong link between movement and music and involves balance and walking, coordination, concenffation and memory.

A

randomrzed, controlled

trial

conducted

in

Geneva

with

subjects aged 65 years

fall

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the prevention ofsarcopenia,the results show thatJques Ddcroze eurhythics may also be ofbenent in lnitigating the consequences Ofthis disease,i.eo gait disorders。

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scen in imction as evaluated using the TUG,balance measled uSing the simphied

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contribution to the continuing lnterest in this fo■

・ ■

.ofphysical exercise。

CONCLUS10N

In moSt Sttdies,physical training programmes produce posit市 e results.The effec―

tiveness of implementation will depend on the ttpe of exercise ttd ic tequency of sessions,as well as the level of compliance with these progralllmes.Only thoSe interventions combining long― term effectiveness and acceptあ ility tte likely to hⅣe a posLive effect on Sarcopenia in the eldedy

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l  Pedersen BK,Febbraio MA.Muscles,exercise and obesity:skeletal muscle as a secrぎ ^{Ory organ。}

Nat Rev Endoc五■o12012;8:457‑65.

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=:」

LttT留 W鶏 ^y瀾 鶴鼈ξ 響富

3柵 当 棚 搬 辮

提 離 斑 挽 ∬

面 血 呼 ^r

extremities in wolnen and inen.J GerontolA

4脚 _{鶉 淵轟 m胤 認冨 :ittf蹴 群}

_:悩

_{舞 l導 き く色 ]蹴}

_:

1994;330:1769‑75。

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6  Kumarv SelbyA,Radcin D,Patel R,Athertl :l

ie dose…response relationship ofmuSde pro men.J Physio1 2009;587:211‐^17.

7  Cuthbertson D,SImth K,Babr可 I Lcese G,Waddell■ A■erton R cι  αJ・ Anあolic signaling dencits underlie almo aCid resistance ofwasting,aging musCle.FASEB J 2005;19:422‐ ^4.

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Gill TM, Baker DI, Gottschalk M,PeduzziPN, Atlore H, Byers A. A program _to prevent functional decline in physically frail, elder$ persons who live at home. N Engl J Med 2002;347 1068-74.

Campbell WW, Leidy HJ. Dietary protein and resistance training effects on muscle and body composition in olderpersons. JAm Coll Nutr 2007;26:6965-7035.

Trombetti A, Hars M, Herrmann FR, Kressig RW, Ferrari S, Rizzoli R. Effect of music-based multitask haining on gait, balance, and fall risk in elderly people: a randomized conholled trial.

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