A Review on Aging, Sarcopenia, Falls, and Resistance Training in Community-Dwelling Older Adults

Filipe Rodrigues, Christophe Domingos, Diogo Monteiro, Pedro Morouço, Filipe Rodrigues, Christophe Domingos, Diogo Monteiro, Pedro Morouço

Abstract

As aging continues to grow in our society, sarcopenia and associated fall risk is considered a public health problem since falling is the third cause of chronic disability. Falls are negatively related to functionality and independence and positively associated with morbidity and mortality. The cost of treatment of secondary injuries related to falls is high. For example, one in ten fall incidents leads to bone fractures and several other comorbidities. As demonstrated by several experimental studies, adopting a more active lifestyle is critical for reducing the number of fall episodes and their consequences. Therefore, it is essential to debate the proven physical exercise methods to reduce falls and fall-related effects. Since muscle mass, muscle strength, bone density, and cartilage function may play significant roles in daily activities, resistance training may positively and significantly affect the elderly. This narrative review aimed to examine current evidence on existing resistance training using resistance machines and bodyweight or low-cost equipment for the elderly and how they are related to falls and fall-related consequences. We provide theoretical links between aging, sarcopenia, and falls linking to resistance training and offer practical suggestions to exercise professionals seeking to promote regular physical exercise to promote quality of life in this population. Exercise programs focusing on strength may significantly influence muscle mass and muscle strength, minimizing functional decline and risk of falling. Resistance training programs should be customized to each elderly according to age, sex, and other fundamental and individual aspects. This narrative review provides evidence to support recommendations for practical resistance training in the elderly related to intensity and volume. A properly designed resistance training program with adequate instructions and technique is safe for the elderly. It should include an individualized approach based on existing equipment (i.e., body weight, resistance machines). Existing literature shows that exercise performance towards 2-3 sets of 1-2 exercises per major muscle group, performing 5-8 repetitions or achieving intensities of 50-80% of 1RM, 2-3 times per week should be recommended, followed by training principles such as periodization and progression. Bearing this in mind, health and exercise professionals should combine efforts focusing on efficient strategies to reduce falls among the elderly and promote higher experiences of well-being at advanced stages in life.

Keywords: aging; elderly; fall; resistance training; sarcopenia.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Chemical shift encoding-based water-fat magnetic resonance imaging (MRI) and placement of regions of interest (ROIs). (a) Representative proton density fat fraction (PDFF) map. (b) PDFF map with superimposition of manually segmented muscle compartments defined as ROIs: (1) right quadriceps muscle, (2) left quadriceps muscle, (3) right ischiocrural muscles, and (4) left ischiocrural muscles. The red lines around the thigh represent the segmentation of the entire thigh contour. Reused from [22] under Creative Commons license.

References

    1. United Nations . World Population Ageing 2019 (ST/ESA/SER. A/444) United Nations, Department of Economic and Social Affairs, Population Division; New York, NY, USA: 2020.
    1. World Health Organization Ageing and Health Report. [(accessed on 19 September 2021)]. Available online: .
    1. European Comission . The 2018 Ageing Report: Economic and Budgetary Projections for the EU Member States (2016–2070) European Comission; Geneva, Switzerland: 2018.
    1. Landi F., Liperoti R., Russo A., Capoluongo E.D., Barillaro C., Pahor M., Bernabei R., Onder G. Disability, more than multimorbidity, was predictive of mortality among older persons aged 80 years and older. J. Clin. Epidemiol. 2010;63:752–759. doi: 10.1016/j.jclinepi.2009.09.007.
    1. Ruiz J.R., Sui X., Lobelo F., Morrow J.R., Jackson A.W., Sjöström M., Blair S.N. Association between muscular strength and mortality in men: Prospective cohort study. BMJ. 2008;337:a439. doi: 10.1136/bmj.a439.
    1. Merchant R.A., Morley J.E., Izquierdo M. Exercise, Aging and Frailty: Guidelines for Increasing Function. J. Nutr. Health Aging. 2021;25:405–409. doi: 10.1007/s12603-021-1590-x.
    1. Benavent-Caballer V., Rosado-Calatayud P., Segura-Ortí E., Amer-Cuenca J., Lisón J. Effects of three different low-intensity exercise interventions on physical performance, muscle CSA and activities of daily living: A randomized controlled trial. Exp. Gerontol. 2014;58:159–165. doi: 10.1016/j.exger.2014.08.004.
    1. Bishop N.A., Lu T., Yankner B.A. Neural mechanisms of ageing and cognitive decline. Nature. 2010;464:529–535. doi: 10.1038/nature08983.
    1. Cadore E.L., Casas-Herrero A., Zambom-Ferraresi F., Idoate F., Millor N., Gómez M., Rodríguez-Mañas L., Izquierdo M. Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenarians. AGE. 2014;36:773–785. doi: 10.1007/s11357-013-9586-z.
    1. World Health Organization . Depression and Other Common Mental Disorders: Global Health Estimates. World Health Organization; Geneva, Switzerland: 2017. pp. 1–24.
    1. Freiberger E., Menz H., Abu-Omar K., Rütten A. Preventing Falls in Physically Active Community-Dwelling Older People: A Comparison of Two Intervention Techniques. Gerontology. 2007;53:298–305. doi: 10.1159/000103256.
    1. Cruz-Jentoft A.J., Bahat G., Bauer J., Boirie Y., Bruyère O., Cederholm T., Cooper C., Landi F., Rolland Y., Sayer A.A., et al. Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. Sarcopenia: Revised European consensus on definition and diagnosis. Age Ageing. 2019;48:16–31. doi: 10.1093/ageing/afy169.
    1. Doherty T.J. Invited Review: Aging and sarcopenia. J. Appl. Physiol. 2003;95:1717–1727. doi: 10.1152/japplphysiol.00347.2003.
    1. Phu S., Boersma D., Duque G. Exercise and Sarcopenia. J. Clin. Densitom. 2015;18:488–492. doi: 10.1016/j.jocd.2015.04.011.
    1. Beurskens R., Gollhofer A., Muehlbauer T., Cardinale M., Granacher U. Effects of Heavy-Resistance Strength and Balance Training on Unilateral and Bilateral Leg Strength Performance in Old Adults. PLoS ONE. 2015;10:e0118535. doi: 10.1371/journal.pone.0118535.
    1. Liguori G., American College of Sports Medicine . ACSM’s Guidelines for Exercise Testing and Prescription. Lippincott Williams & Wilkins; Philadelphia, PA, USA: 2020.
    1. Montero-Fernandez N., Serra-Rexach J.A. Role of exercise on sarcopenia in the elderly. Eur. J. Phys. Rehabil. Med. 2013;49:131–143.
    1. Larsson L., Degens H., Li M., Salviati L., Lee Y.I., Thompson W., Kirkland J.L., Sandri M. Sarcopenia: Aging-Related Loss of Muscle Mass and Function. Physiol. Rev. 2019;99:427–511. doi: 10.1152/physrev.00061.2017.
    1. Cruz-Jentoft A.J., Baeyens J.P., Bauer J.M., Boirie Y., Cederholm T., Landi F., Martin F.C., Michel J.-P., Rolland Y., Schneider S.M., et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39:412–423. doi: 10.1093/ageing/afq034.
    1. Pahor M., Manini T., Cesari M. Sarcopenia: Clinical evaluation, biological markers and other evaluation tools. J. Nutr. Health Aging. 2009;13:724–728. doi: 10.1007/s12603-009-0204-9.
    1. Edmunds K., Gíslason M., Sigurðsson S., Guðnason V., Harris T., Carraro U., Gargiulo P. Advanced quantitative methods in correlating sarcopenic muscle degeneration with lower extremity function biometrics and comorbidities. PLoS ONE. 2018;13:e0193241. doi: 10.1371/journal.pone.0193241.
    1. Inhuber S., Sollmann N., Schlaeger S., Dieckmeyer M., Burian E., Kohlmeyer C., Karampinos D.C., Kirschke J.S., Baum T., Kreuzpointner F., et al. Associations of thigh muscle fat infiltration with isometric strength measurements based on chemical shift encoding-based water-fat magnetic resonance imaging. Eur. Radiol. Exp. 2019;3:45. doi: 10.1186/s41747-019-0123-4.
    1. Delbono O., Rodrigues A.C.Z., Bonilla H.J., Messi M.L. The emerging role of the sympathetic nervous system in skeletal muscle motor innervation and sarcopenia. Ageing Res. Rev. 2021;67:101305. doi: 10.1016/j.arr.2021.101305.
    1. Keller K., Engelhardt M. Strength and muscle mass loss with aging process. Age and strength loss. Muscle Ligaments Tendons J. 2019;3:346–350. doi: 10.32098/mltj.04.2013.17.
    1. Freiberger E., Haeberle L., Spirduso W.W., Zijlstra G.A.R. Long-Term Effects of Three Multicomponent Exercise Interventions on Physical Performance and Fall-Related Psychological Outcomes in Community-Dwelling Older Adults: A Randomized Controlled Trial. J. Am. Geriatr. Soc. 2012;60:437–446. doi: 10.1111/j.1532-5415.2011.03859.x.
    1. Bruyere O., Wuidart M.-A., Di Palma E., Gourlay M., Ethgen O., Richy F., Reginster J.-Y. Controlled whole body vibration to decrease fall risk and improve health-related quality of life of nursing home residents. Arch. Phys. Med. Rehabil. 2005;86:303–307. doi: 10.1016/j.apmr.2004.05.019.
    1. Álvarez-Barbosa F., del Pozo-Cruz J., del Pozo-Cruz B., Rosa R.M.A., Rogers M.E., Zhang Y. Effects of supervised whole body vibration exercise on fall risk factors, functional dependence and health-related quality of life in nursing home residents aged 80+ Maturitas. 2014;79:456–463. doi: 10.1016/j.maturitas.2014.09.010.
    1. Healee D.J., McCallin A., Jones M. Older adult’s recovery from hip fracture: A literature review. Int. J. Orthop. Trauma Nurs. 2011;15:18–28. doi: 10.1016/j.ijotn.2010.06.010.
    1. Gillespie L.D., Robertson M.C., Gillespie W.J., Sherrington C., Gates S., Clemson L.M., Lamb S.E. Interventions for preventing falls in older people living in the community. Cochrane Database Syst. Rev. 2012;9:CD007146. doi: 10.1002/14651858.cd007146.pub3.
    1. Zhuang J., Huang L., Wu Y., Zhang Y. The effectiveness of a combined exercise intervention on physical fitness factors related to falls in community-dwelling older adults. Clin. Interv. Aging. 2014;9:131–140. doi: 10.2147/CIA.S56682.
    1. Kannus P., Sievänen H., Palvanen M., Järvinen T., Parkkari J. Prevention of falls and consequent injuries in elderly people. Lancet. 2005;366:1885–1893. doi: 10.1016/S0140-6736(05)67604-0.
    1. Gillespie L.D., Gillespie W.J., Robertson M.C., Lamb S.E., Cumming R.G., Rowe B.H. Interventions for preventing falls in elderly people. Cochrane Database Syst. Rev. 2003;4:CD000340. doi: 10.1002/14651858.cd000340.
    1. Duncan P.W., Weiner D.K., Chandler J., Studenski S. Functional Reach: A New Clinical Measure of Balance. J. Gerontol. 1990;45:M192–M197. doi: 10.1093/geronj/45.6.M192.
    1. El-Sharif S.I., Al-Harbi A.B., Al-Shihabi A.M., Al-Daour D.S., Sharif R.S. Falls in the elderly: Assessment of prevalence and risk factors. Pharm. Pract. 2018;16:1206. doi: 10.18549/pharmpract.2018.03.1206.
    1. Maidan I., Droby A., Jacob Y., Giladi N., Hausdorff J.M., Mirelman A. The neural correlates of falls: Alterations in large-scale resting-state networks in elderly fallers. Gait Posture. 2020;80:56–61. doi: 10.1016/j.gaitpost.2020.05.023.
    1. Hughes V.A., Frontera W.R., Wood M., Evans W.J., Dallal G.E., Roubenoff R., Singh M.A.F. Longitudinal Muscle Strength Changes in Older Adults: Influence of Muscle Mass, Physical Activity, and Health. J. Gerontol. Ser. A. 2001;56:B209–B217. doi: 10.1093/gerona/56.5.B209.
    1. Spirduso W.W. Physical Activity and Aging: Retrospections and Visions for the Future. J. Aging Phys. Act. 1994;2:233–242. doi: 10.1123/japa.2.3.233.
    1. Beaudart C., Rizzoli R., Bruyère O., Reginster J.-Y., Biver E. Sarcopenia: Burden and challenges for public health. Arch. Public Health. 2014;72:45. doi: 10.1186/2049-3258-72-45.
    1. Santos D., Silva A., Baptista F., Santos R., Vale S., Mota J., Sardinha L.B. Sedentary behavior and physical activity are independently related to functional fitness in older adults. Exp. Gerontol. 2012;47:908–912. doi: 10.1016/j.exger.2012.07.011.
    1. Lopez P., Pinto R.S., Radaelli R., Rech A., Grazioli R., Izquierdo M., Cadore E. Benefits of resistance training in physically frail elderly: A systematic review. Aging Clin. Exp. Res. 2018;30:889–899. doi: 10.1007/s40520-017-0863-z.
    1. Sousa N., Mendes R., Abrantes C., Sampaio J. Differences in Maximum Upper and Lower Limb Strength in Older Adults after a 12 Week Intense Resistance Training Program. J. Hum. Kinet. 2011;30:183–188. doi: 10.2478/v10078-011-0086-x.
    1. Pirker W., Katzenschlager R. Gait disorders in adults and the elderly: A clinical guide. Wien. Klin. Wochenschr. 2016;129:81–95. doi: 10.1007/s00508-016-1096-4.
    1. Nelson M.E., Rejeski W.J., Blair S.N., Duncan P.W., Judge J.O., King A.C., Macera C.A., Castaneda-Sceppa C. Physical activity and public health in older adults: Recommendation from the American College of Sports Medicine and the American Heart Association. Circulation. 2007;116:1094–1105. doi: 10.1249/mss.0b013e3180616aa2.
    1. Phillips S.M., Winett R.A. Uncomplicated Resistance Training and Health-Related Outcomes: Evidence for a public health mandate. Curr. Sports Med. Rep. 2010;9:208–213. doi: 10.1249/JSR.0b013e3181e7da73.
    1. Kraemer W.J., Ratamess N.A. Fundamentals of Resistance Training: Progression and Exercise Prescription. Med. Sci. Sports Exerc. 2004;36:674–688. doi: 10.1249/01.MSS.0000121945.36635.61.
    1. Fragala M.S., Cadore E.L., Dorgo S., Izquierdo M., Kraemer W.J., Peterson M.D., Ryan E.D. Resistance Training for Older Adults: Position Statement From the National Strength and Conditioning Association. J. Strength Cond. Res. 2019;33:2019–2052. doi: 10.1519/JSC.0000000000003230.
    1. Law T.D., Clark L.A., Clark B.C. Resistance Exercise to Prevent and Manage Sarcopenia and Dynapenia. Annu. Rev. Gerontol. Geriatr. 2016;36:205–228. doi: 10.1891/0198-8794.36.205.
    1. Kraemer W.J., Adams K., Cafarelli E., Dudley G.A., Dooly C., Feigenbaum M.S., Fleck S.J., Franklin B., Fry A.C., Hoffman J., et al. Progression Models in Resistance Training for Healthy Adults. Med. Sci. Sports Exerc. 2002;34:364–380. doi: 10.1097/00005768-200202000-00027.
    1. Borde R., Hortobágyi T., Granacher U. Dose–Response Relationships of Resistance Training in Healthy Old Adults: A Systematic Review and Meta-Analysis. Sports Med. 2015;45:1693–1720. doi: 10.1007/s40279-015-0385-9.
    1. Hart P.D., Buck D.J. The effect of resistance training on health-related quality of life in older adults: Systematic review and meta-analysis. Health Promot. Perspect. 2019;9:1–12. doi: 10.15171/hpp.2019.01.
    1. Peterson M.D., Rhea M.R., Sen A., Gordon P. Resistance exercise for muscular strength in older adults: A meta-analysis. Ageing Res. Rev. 2010;9:226–237. doi: 10.1016/j.arr.2010.03.004.
    1. Talar K., Hernández-Belmonte A., Vetrovsky T., Steffl M., Kałamacka E., Courel-Ibáñez J. Benefits of Resistance Training in Early and Late Stages of Frailty and Sarcopenia: A Systematic Review and Meta-Analysis of Randomized Controlled Studies. J. Clin. Med. 2021;10:1630. doi: 10.3390/jcm10081630.
    1. Mañas A., Gómez-Redondo P., Valenzuela P.L., Morales J.S., Lucía A., Ara I. Unsupervised home-based resistance training for community-dwelling older adults: A systematic review and meta-analysis of randomized controlled trials. Ageing Res. Rev. 2021;69:101368. doi: 10.1016/j.arr.2021.101368.
    1. Skelton D.A., Young A., Greig C.A., Malbut K.E. Effects of Resistance Training on Strength, Power, and Selected Functional Abilities of Women Aged 75 and Older. J. Am. Geriatr. Soc. 1995;43:1081–1087. doi: 10.1111/j.1532-5415.1995.tb07004.x.
    1. Hruda K.V., Hicks A.L., McCartney N. Training for Muscle Power in Older Adults: Effects on Functional Abilities. Can. J. Appl. Physiol. 2003;28:178–189. doi: 10.1139/h03-014.
    1. Kim H.K., Suzuki T., Saito K., Yoshida H., Kobayashi H., Kato H., Katayama M. Effects of Exercise and Amino Acid Supplementation on Body Composition and Physical Function in Community-Dwelling Elderly Japanese Sarcopenic Women: A Randomized Controlled Trial. J. Am. Geriatr. Soc. 2012;60:16–23. doi: 10.1111/j.1532-5415.2011.03776.x.
    1. Kim H., Suzuki T., Saito K., Yoshida H., Kojima N., Kim M., Sudo M., Yamashiro Y., Tokimitsu I. Effects of exercise and tea catechins on muscle mass, strength and walking ability in community-dwelling elderly Japanese sarcopenic women: A randomized controlled trial. Geriatr. Gerontol. Int. 2013;13:458–465. doi: 10.1111/j.1447-0594.2012.00923.x.
    1. Kim H., Suzuki T., Kim M., Kojima N., Ota N., Shimotoyodome A., Hase T., Hosoi E., Yoshida H. Effects of Exercise and Milk Fat Globule Membrane (MFGM) Supplementation on Body Composition, Physical Function, and Hematological Parameters in Community-Dwelling Frail Japanese Women: A Randomized Double Blind, Placebo-Controlled, Follow-Up Trial. PLoS ONE. 2015;10:e0116256. doi: 10.1371/journal.pone.0116256.
    1. Vasconcelos K.S.S., Dias J.M.D., Araújo M.C., Pinheiro A.C., Moreira B.S., Dias R.C. Effects of a progressive resistance exercise program with high-speed component on the physical function of older women with sarcopenic obesity: A randomized controlled trial. Braz. J. Phys. Ther. 2016;20:432–440. doi: 10.1590/bjpt-rbf.2014.0174.
    1. Huang S.-W., Ku J.-W., Lin L.-F., Liao C.-D., Chou L.-C., Liou T.-H. Body composition influenced by progressive elastic band resistance exercise of sarcopenic obesity elderly women: A pilot randomized controlled trial. Eur. J. Phys. Rehabil. Med. 2017;53:556–563. doi: 10.23736/S1973-9087.17.04443-4.
    1. Liao C.-D., Tsauo J.-Y., Huang S.-W., Ku J.-W., Hsiao D.-J., Liou T.-H. Effects of elastic band exercise on lean mass and physical capacity in older women with sarcopenic obesity: A randomized controlled trial. Sci. Rep. 2018;8:2317. doi: 10.1038/s41598-018-20677-7.
    1. Piastra G., Perasso L., Lucarini S., Monacelli F., Bisio A., Ferrando V., Gallamini M., Faelli E., Ruggeri P. Effects of Two Types of 9-Month Adapted Physical Activity Program on Muscle Mass, Muscle Strength, and Balance in Moderate Sarcopenic Older Women. BioMed Res. Int. 2018;2018:5095673. doi: 10.1155/2018/5095673.
    1. Rodrigues F., Macedo R. Exercise Promotion: Reviewing the Importance of Health Professionals’ Interpersonal Behaviors on Exercisers’ Basic Psychological Needs. Percept. Mot. Ski. 2021;128:800–812. doi: 10.1177/0031512520983078.
    1. Rodrigues F., Teixeira D.S., Cid L., Monteiro D. Promoting Physical Exercise Participation: The Role of Interpersonal Behaviors for Practical Implications. J. Funct. Morphol. Kinesiol. 2019;4:40. doi: 10.3390/jfmk4020040.

Source: PubMed

3
订阅