20 years 80 years - Fysioterapeuterna · Per Aagaard Institute of Sports Science and Clinical...
Transcript of 20 years 80 years - Fysioterapeuterna · Per Aagaard Institute of Sports Science and Clinical...
1
Loss in muscle mass and
neuromuscular function with aging
- Use of exercise as a countermeasure
Per Aagaard
Institute of Sports Science and Clinical Biomechanics,
University of Southern Denmark / [email protected]
Department of Physiotherapy, Institute of Neuroscience & Physiology,
Sahlgrenska Academy, University of Göteborg
“Träning för äldre”
Utbildningsdag Sjukgymnastdagarna, Göteborg October 4th, 2013
20 years 80 years20 years 80 years
Aging ….. the continuum of life
“Träning för äldre”
Utbildningsdag Sjukgymnastdagarna, Göteborg October 4th, 2013
Presentation Outline
Changes in muscle mass and
neuromuscular function with aging
Effects of strength training in elderly on...
- Muscle mass and neuromuscular function
- Mechanical muscle function (strength, RFD, Power)
- Rehabilitation in patients
- Functional capacity
“Träning för äldre”
Utbildningsdag Sjukgymnastdagarna, Göteborg October 4th, 2013
2
“Träning för äldre”
Utbildningsdag Sjukgymnastdagarna, Göteborg October 4th, 2013
Age-related changes in neuromuscular function
Loss of muscle mass with aging: Sarcopenia
Paolo Caserotti, NIH Besthesda & IOB-SDU
Vandervoort, Muscle & Nerve 25, 2002
Parise & Yarasheski,
Curr Opin Clin Nutr Metab Care, 2000
31 yr (m)
66 yr (m)
73 yr (f)
85 yr (f)
Loss of muscle mass with aging:
sarcopenia
Reduced muscle cross-sectional area
( 40% between the age of 20 and 80 yrs)
The decline seems to start in early
adulthood and accelerate after the age of
50 years
content of non-contractile tissue such as
intramuscular fat and connective tissue
Cross-sectional images of the QUADRICEPS muscle (MRI)
62-yr old woman 81-yr old woman
Caserotti, Aagaard et al 2008
Vandervoort, Muscle & Nerve 25, 2002
Parise & Yarasheski,
Curr Opin Clin Nutr Metab Care, 2000
31 yr (m)
66 yr (m)
73 yr (f)
85 yr (f)
Loss of muscle mass with aging:
sarcopenia
Reduced muscle cross-sectional area
( 40% between the age of 20 and 80 yrs)
The decline seems to start in early
adulthood and accelerate after the age of
50 years
content of non-contractile tissue such as
intramuscular fat and connective tissue
"Sarcopenic obesity"
3
Reduction in muscle fiber size with aging
Young
subject
Old
subject
VL stainings courtesy
JL Andersen
CMRC 2004
courtesy C Suetta
Sarcopenia (loss of muscle mass)
Sarcopenia is significantly associated with... 3-4 times greater risk of physical disability 2-3 times greater risk of balance abnormality
2-3 times greater risk of falls Baumgartner RN 1998, 1999
In frail elderly persons with advanced sarcopenia
but without circulatory or pulmonary diseases,
muscle weakness is typically more limiting for
daily functioning than aerobic fitness.
Photo courtesy
Charlotte Suetta
4
SARCOPENIA
Reduced Muscle Mass with Ageing
The result of aging per se
or due to reduced
physical activity
/ increased inactivity?
Studies in ageing Master Athletes
Korhonen et al, J Appl Physiol 2006
Reduced Muscle Fiber size with ageing
Muscle fiber size in young vs aging sprinters:
trend for decreased fiber area with increase in age
Type I fibers Type IIA
Type IIAX Type IIX
SARCOPENIA
Reduced Muscle Mass with Ageing
The result of aging per se
or due to reduced
physical activity
/ increased inactivity?
Muscle size is reduced also in
physically active individuals
... aging does play a role
5
Age-related changes in neuromuscular function
Loss of spinal motor neurons,
CNS reorganization
“Träning för äldre”
Utbildningsdag Sjukgymnastdagarna, Göteborg October 4th, 2013
Spinal motor neurons
reduced number of motor
neurons in the spinal cord
25% average loss of spinal motor
neurons (lumbospinal segments L1-S3)
from 20 yrs to 90 yrs of age
Tomlinson & Irving 1977
several subjects > 60 yrs
showing ~ 50% less MN's
compared to 20-40 yrs old
Tomlinson & Irving 1977
Brainmotor cortex
cerebellum
Spinal
cord
Muscle
spinal motor neurons
Neural factors - neuromuscular function
spinal motor neurons, nerve axons, motor units
Reduced muscle mass, muscle CSA
Total fiber number Muscle fiber size
Muscle strength
Motor unit number
# Spinal motor neurons
Motor unit size
innervation ratio (# fibers/neuron)
Motor Unit remodeling
Vandervoort, Muscle & Nerve 25, 2002
Neuromuscular changes related to aging
Spinal motor neurons
reduced number of motor
neurons in the spinal cord
25% average loss of spinal motor
neurons (lumbospinal segments L1-S3)
from 20 yrs to 90 yrs of age
Tomlinson & Irving 1977
several subjects > 60 yrs
showing ~ 50% less MN's
compared to 20-40 yrs old
Tomlinson & Irving 1977
Brainmotor cortex
cerebellum
Spinal
cord
Muscle
spinal motor neurons
Neural factors - neuromuscular function
spinal motor neurons, nerve axons, motor units
# motor neurons = # motor units
at increasing age
ongoing process of
denervation
of skeletal muscle fibers late in life
Vandervoort 2002, McComas 1996
AJ McComas: Skeletal muscle
- form and function, 1996
Reduced muscle mass, muscle CSA
Total fiber number Muscle fiber size
Muscle strength
Motor unit number
# Spinal motor neurons
Motor unit size
innervation ratio (# fibers/neuron)
Motor Unit remodeling
Vandervoort, Muscle & Nerve 25, 2002
Neuromuscular changes related to aging
spinal motor neurons
Muscle fibers
motor axon
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# motor neurons = # motor units
at increasing age
ongoing process of
denervation and reinnervation
of skeletal muscle fibers late in life
evidenced by
- histological findings of fiber type grouping
- elevated coexpression of MHC isoforms
- preferential atrophy of type II muscle fibers
- very large MUAPs, indicating innervation ratio
Vandervoort 2002, McComas 1996AJ McComas: Skeletal muscle
- form and function, 1996
Reduced muscle mass, muscle CSA
Total fiber number Muscle fiber size
Muscle strength
Motor unit number
# Spinal motor neurons
Motor unit size
innervation ratio (# fibers/neuron)
Motor Unit remodeling
Vandervoort, Muscle & Nerve 25, 2002
Neuromuscular changes related to aging
spinal motor neurons
Muscle fibers
motor axon
Motor unit number
# Spinal motor neurons
Motor unit size
innervation ratio (# fibers/neuron)
Motor Unit remodeling
Reduced muscle mass cross sectional area
Total fiber number Muscle fiber size (pref. type II)
Muscle strength
SUMMARY - Muscular and Neuronal changes induced by Ageing
Aagaard et al, Scand J Med Sci Sports 20, 2010
Motor unit number
# Spinal motor neurons
Motor unit size
innervation ratio (# fibers/neuron)
Motor Unit remodeling
Reduced muscle mass cross sectional area
Total fiber number Muscle fiber size (pref. type II)
Muscle strength
SUMMARY - Muscular and Neuronal changes induced by Ageing
Aagaard et al, Scand J Med Sci Sports 20, 2010
CONSEQUENCES
FOR MECHANICAL
MUSCLE
PERFORMANCE?
7
Age-related changes in neuromuscular function
Impairments in mechanical muscle function
“Träning för äldre”
Utbildningsdag Sjukgymnastdagarna, Göteborg October 4th, 2013
Decreased Muscular Strength With Aging
Isometric muscle strength
Is preserved to ~50-60 yrs of age
(cross sectional data)
Decreases at a rate of 1-1.5%
per year from 60-65th year
Substantial individual differences !
Spirduso, Physical dimensions of aging, 1995
Vandervoort & McComas 1986
Spirdoso 1995
Decreased Muscular Strength With Aging
Isometric muscle strength
Is preserved to ~50-60 yrs of age
(cross sectional data)
Decreases at a rate of 1-1.5%
per year from 60-65th year
Substantial individual differences !
Spirduso, Physical dimensions of aging, 1995
Vandervoort & McComas 1986
Spirdoso 1995
Peak Power
Mean Power
Peak Power
Mean Power
trained untrained
Pearson, Harridge et al;
Med Sci Sports Exerc 2002
Maximal Muscle Power - elite master weightlifters
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Maximal Muscle Power - elite master weightlifters
Peak Power
Mean Power
Peak Power
Mean Power
trained untrained
Pearson, Harridge et al;
Med Sci Sports Exerc 2002
Trained (closed circles) and
untrained (open circles)
individuals demonstrated
similar age-related decline
rate in peak power (1.3%
vs 1.2% per year, respectively)
Peak Power
Mean Power
20 years
Peak Power
Mean Power
trained untrained
Pearson, Harridge et al;
Med Sci Sports Exerc 2002
Trained (closed circles) and
untrained (open circles)
individuals demonstrated
similar age-related decline
rate in peak power (1.3%
vs 1.2% per year, respectively)
Maximal Muscle Power - elite master weightlifters
Maximal leg extensor
muscle power assessed
by force plate analysis
Maximal counter-movement
jumps: Stretch-Shortening
Cycle muscle power Caserotti, Aagaard et al EJAP 2001,
Thorlund, Aagaard et al SJMSS 2008,
Edwén, Aagaard et al SJMSS 2013
Maximal SSC Muscle Power - Women vs Men?
Cecilia Edwén
et al SJMSS 2013
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Is maximal muscle power and rapid force
capacity (RFD: rate of force development)
important in elderly individuals ?
Is maximal muscle power and rapid force
capacity (RFD: rate of force development)
important in elderly individuals ?
YES !
Functional performance in the elderly is influenced by maximal mechanical muscle power
Men
Women
r=.83***r=.45
r=.86***r=.91***
r=.93***r=.58*
*P<0.05
***P<0.001
Leg extensor power (W/kg) Leg extensor power (W/kg)
Sta
ir-c
lim
bin
g s
pe
ed
(m
/s)
Wa
lkin
g s
pe
ed
(m
/s)
Ch
air
ris
ing
sp
ee
d (
s-1
)
Bassey et al, 1992
Nursing Home residents
Functional capacity in the elderly is strongly
influenced by maximal mechanical muscle power
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Can the age-related loss in muscle mass, and decrease in
muscle strength and power be slowed or reversed by training ?
Can the age-related loss in muscle mass, and decrease in
muscle strength and power be slowed or reversed by training ?
Can the age-related impairment in neural function
be effectively compensated by training ?
Brainmotor cortex
cerebellum
Spinal
cord
Muscle
Can the age-related loss in muscle mass, and decrease in
muscle strength and power be slowed or reversed by training ?
Can the age-related impairment in neural function
be effectively compensated by training ?
YES !
.... by means of strength / resistance training
11
“Träning för äldre”
Utbildningsdag Sjukgymnastdagarna, Göteborg October 4th, 2013
Age-related changes in neuromuscular function
- Effects of strength training in old adults
Adaptive alterations in muscle size,
neuromuscular activity
and mechanical muscle function
Narici et al: Training-induced changes in elderly muscle,
J. Musculoskel. Neron. Interact. 4, 2004
Ferri 2003
Frontera 1988
Häkkinen 1998
Harridge 1999
Häkkinen 1985
Jones & Rutherford 1987
Narici 1996
Percentage increases in muscle CSA and Maximal muscle
strength (MVC) with Strength Training in old vs young individuals
85 year old discharged geriatric patients
12 weeks of resistance exercise
- isolated knee extensor exercise
- 3 session per week,
- 3 sets x 8 rep,
- training loads >70% 1 RM
Kryger & Andersen,
Scand J Med Sci Sports 2007
Heavy-resistance strength training induces muscle fiber growth
also in very old individuals (85-97 yrs, mean age 89 ± 3 yrs)
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Kryger & Andersen
Scand J Med Sci Sports 2007
Heavy-resistance strength training induces muscle fiber growth
also in very old individuals (85 yrs)
Mean age 89 ± 3 yrs (n=11), 3 sessions weekly, 12 wks
Results
Type IIa fibre CSA 22% *
Quadriceps strength 40-45% *
Chair rising time (5 reps) 30% faster *
Maximal walking speed 25% faster *
* p < 0.05
85 year old discharged geriatric patients
12 weeks of resistance exercise
knee ext. 3 x weekly, 3 x 8 rep, >70% 1 RM
Kryger & Andersen,
Scand J Med Sci Sports 2007
Heavy-resistance strength training induces muscle fiber growth
also in very old individuals (85-97 yrs, mean age 89 ± 3 yrs)
Increases in muscle fibre size in older individuals following
high-intensity dynamic leg strength training. Based on
biopsy samples obtained from vastus lateralis
Study
Muscle fiber size
increase (%)
Type I Type II
Frontera et al., J. Appl.
Physiol. 64, 1988
34
26
7
20
8
5
Häkkinen et al.
J. Gerontol. 53B, 1998 23
27
Fiatarone-Singh et al.
Am. J. Physiol. 277, 1999
5
-12
Hunter et al., J. Appl.
Physiol. 86, 1999
14
23
Hikida et al.
J. Gerontol. 55, 2000
46
43
Vandervoort, Muscle & Nerve 25, 2002
>
<
<
Charette et al., J. Appl.
Physiol. 70, 1991
Grimby et al., J. Appl.
Physiol. 73, 1992
13
Maximal Explosive Muscle Strength
1000
2000
3000
4000
5000
0
0.20 0.4 0.6 0.8
Time (seconds)
Fo
rce
(N
)
RFD =
Force / Time
F
orc
e
Time
max Force
Rate of Force Development (RFD)Maximal Explosive Muscle Strength
1000
2000
3000
4000
5000
0
0.20 0.4 0.6 0.8
Time (seconds)
Fo
rce
(N
)
RFD =
Force / Time
F
orc
e
Time
max Force
Rate of Force Development (RFD)
Contractile Rate of Force Development (RFD) Rapid Force Capacity (Explosive muscle strength)
Aagaard et al, J Appl Physiol 2002
Clarckson et al 1981, Häkkinen et al 1995,
Izquierdo et al 1999, Barry et al. 2005,
Korhonen et al 2006, Klass et al 2008,
Suetta, Kjær, Aagaard et al 2009
RFD Contractile Rate of Force Development
Rapid force capacity (RFD) in elderly vs young individuals
Contractile RFD is substantially reduced in
healthy aging individuals compared to young
individualsClarckson et al. 1981, Häkkinen et al. 1995,
Izquierdo et al. 1999, Korhonen et al. 2006,
Klass et al 2008, Suetta, Hvid et al 2008
RFD RFD Contractile Rate of Force Contractile Rate of Force DevelopmentDevelopment
Maximal explosive muscle strength in elderly vs young individuals
1000
2000
3000
4000
5000
0
0.20 0.4 0.6 0.8
Time (seconds)
Fo
rce
(N
)
RFD =RFD =
Force / Time
F
orc
e
Time
max Force
m. quadriceps femoris
Young (24 yr, n=9)
Old (67 yr, n=11)
Suetta, Kjær, Aagaard et al,
J Appl Physiol 2009
* Y < O (p<0.05)
*
*
0-30 ms 50 ms
20
15
10
0
RFD (Nm/s/kg)
Young (67 yr, n=9)
Old (24 yr, n=11)
0-30 ms 50 ms
20
15
10
0
0-30 ms 50 ms
20
15
10
0
0-30 ms 50 ms
20
15
10
0
What is the effect of strength
training on maximal contractile
rate of force development (RFD)
in elderly individuals?
14
Subjects
Mean age 62.7 (SD 2.2) and 81.8 (SD 2.7) yrs
n = 20 + 20 con n = 12 + 13 con
Caserotti, Aagaard et al, SJMSS 2008
Explosive-type resistance training in the old (60 yrs) and the very old (80 yrs)
Subjects
Mean age 62.7 (SD 2.2) and 81.8 (SD 2.7) yrs Duration, frequency
12 weeks, twice a week Familiarization period
2 wks with lower training loads (50% 1RM),
and reduced movement velocity Progressive load adjustment:
Every two weeks with a new estimated 1RM (5-RM test) Exercises (bilateral)
Horizontal leg press, knee extension, calf rise, incline leg
press, leg curl - slow ECC, rapid (max acc) CON actions Exercise intensity and reps
75-80% 1RM loads, 8-10 reps, 4 sets each exercise Caserotti,
Aagaard et al, SJMSS 2008
Explosive-type resistance training in the old (60 yrs) and the very old (80 yrs)
Explosive-type resistance training in the old and the very old
Unilateral isometric leg press test device
Static leg extensor MVC
Paolo Caserotti
15
Fig.2 Representative Maximal Voluntary Contraction recorded during a unilateral isometric leg press
test. F50, F100, F300 and F500 represent the force values recorded after 50, 100, 300 and 500
milliseconds, respectively. Fpeak is the maximal force recorded during this trial.
New
ton
F50
6000
0
200
400
600
800
1000
1200
1400
1600
1800
Fpeak
F500
F300
F100
Force
Time (msec)1000 400030002000 50000
Start of
contraction
New
ton
F50
6000
0
200
400
600
800
1000
1200
1400
1600
1800
Fpeak
F500
F300
F100
Force
Time (msec)1000 400030002000 50000
New
ton
F50
6000
0
200
400
600
800
1000
1200
1400
1600
1800
Fpeak
F500
F300
F100
Force
Time (msec)1000 400030002000 50000
F50
6000
0
200
400
600
800
1000
1200
1400
1600
1800
Fpeak
F500
F300
F100
Force
Time (msec)1000 400030002000 50000
0
200
400
600
800
1000
1200
1400
1600
1800
Fpeak
F500
F300
F100
Force
Time (msec)1000 400030002000 50000
Start of
contraction
Paolo Caserotti
Explosive-type resistance training in the old and the very old
0
30
40
50
60
70
80
*
*
0 week (pre) 12 weeks (post)
TG60CG60TG80CG80
Contractile Rate of Force Development
Leg Press MVC; 0-200 ms
TG60CG60TG80CG80
+18%
+51% 60 yrs old
80 yrs old
TG60CG60TG80CG80
P<0.05 within-group changes
*
(n=20)
(n=20)
(n=12)
(n=13)
Explosive-type resistance training in the old and the very old
marked increases in rapid force capacity (RFD)
Caserotti, Aagaard et al, Scand J Med Sci Sports Exerc 2008
0
30
40
50
60
70
80
*
*
0 week (pre) 12 weeks (post)
TG60CG60TG80CG80
Contractile Rate of Force Development
Leg Press MVC; 0-200 ms
TG60CG60TG80CG80Diff = 43%
p < 0.001
60 yrs old
80 yrs old
TG60CG60TG80CG80
P<0.05 within-group changes
*
(n=20)
(n=20)
(n=12)
(n=13)
Explosive-type resistance training in the old and the very old
marked increases in rapid force capacity (RFD)
Caserotti, Aagaard et al, Scand J Med Sci Sports Exerc 2008
16
0
30
40
50
60
70
80
*
*
0 week (pre) 12 weeks (post)
TG60CG60TG80CG80
Contractile Rate of Force Development
Leg Press MVC; 0-200 ms
TG60CG60TG80CG80
60 yrs old
80 yrs old
TG60CG60TG80CG80
P<0.05 within-group changes
*
(n=20)
(n=20)
(n=12)
(n=13)
Diff = 43%
p < 0.001
Diff = 15% n.s.
Explosive-type resistance training in the old and the very old
marked increases in rapid force capacity (RFD)
Caserotti, Aagaard et al, Scand J Med Sci Sports Exerc 2008
0
30
40
50
60
70
80
*
*
0 week (pre) 12 weeks (post)
TG60CG60TG80CG80
Contractile Rate of Force Development
Leg Press MVC; 0-200 ms
TG60CG60TG80CG80
60 yrs old
80 yrs old
TG60CG60TG80CG80
P<0.05 within-group changes
*
(n=20)
(n=20)
(n=12)
(n=13)
Diff = 43%
p < 0.001
Diff = 15% n.s.
12 wks of explosive-type
HRST in 80 yr old
20 years younger!
Explosive-type resistance training in the old and the very old
marked increases in rapid force capacity (RFD)
Caserotti, Aagaard et al, Scand J Med Sci Sports Exerc 2008
TG 60 TG80
MVC (maximal strength) +22%* +28%*
RFD (rapid force capacity) +18%* +51%*
SSC muscle power +5%* +6%* (CMJ force plate)
Rapid muscle power +12%* +28%* (Power rig)
* pre vs post (p<0.05)
Explosive-type resistance training in the old and the very old
marked increases in rapid force capacity (RFD)
Caserotti, Aagaard et al, Scand J Med Sci Sports Exerc 2008
17
“Träning för äldre”
Utbildningsdag Sjukgymnastdagarna, Göteborg October 4th, 2013
Age-related changes in neuromuscular function
- Effects of strength training in elderly patients
Adaptive alterations in muscle size,
neuromuscular activity
and functional capacity
Effects of strength training in
elderly patients
Well, does the need exist?
Strength training is the only exercise modality
known to effectively increase muscle mass
Substantial muscle atrophy
is observed with long-term
disuse, such as in
- hip or knee arthrosis,
- COPD,
- type 2 diabetes
- and many other types of
chronic disease...
Effects of strength training in
elderly patients
Well, does the need exist?
Significant muscle atrophy
may be observed in
response to acute
short-term disuse
(4-14 days immobilization)
... recovery is more
difficult to achieve in
old individuals!
Quadriceps muscle CSA
(24 yrs)
(67 yrs)
Hvid, Aagaard, Suetta et al,
J Appl Physiol 2009
18
Effects of strength training in
elderly patients
Well, does the need exist?
Significant muscle atrophy
may be observed in
response to acute
short-term disuse
(4-14 days immobilization)
... recovery is more
difficult to achieve in
old individuals!
Suetta, Aagaard et al, J Physiol 2013
Young
Old
(24 yrs)
(67 yrs)
Effects of resistance training rehabilitation on
muscle mass and functional capacity in elderly
hip replacement patients
Suetta, Aagaard et al, J Appl Physiol 2004
MVC
Biopsy
UL-scan
0 5 12 Wks
+ unilateral Electrical Stimulation (n=10) - ES
S
U
R
G
E
R
Y
+ unilateral Strength Training (n=10) - ST
Standard Rehabilitation (n=8) - SR
60 yrs
-1
MVC
Biopsy
UL-scan
MVC
Biopsy
UL-scan
MVC
Rehabilitation of muscle mass and neuromuscular function
following Hip Replacement Surgery in old adults (60-86 yrs)
by use of resistance training
Suetta, Aagaard, Kjaer et al, J Appl Physiol 2004
19
Strength Training protocol
Strength exercises - heavy loads
unilateral heavy-resistance strength training - Affected Limb
Leg-
press
Knee-
extension
Wks 1-2: 3x10 (20 RM), Wks 3-4: 3x12 (15 RM), Wks 5-6: 4x10 (12 RM)
Wks 7-8: 5x8 (8 RM), Wks 9-10: 4x8 (8 RM), Wks 11-12: 3x8 (8 RM)
Suetta, Aagaard et al, J Appl Physiol 2004
Rehabilitation from elective Hip replacement Surgery by use of Strength Training
*#
CS
A(m
m²)
0
3000
4000
5000
6000
Pre 5wk 12wkPre 5wk 12wkPre 5wk 12wk
*
§**
*#
*#
CS
A(m
m²)
0
3000
4000
5000
6000
Pre 5wk 12wkPre 5wk 12wkPre 5wk 12wk
*
§**
CS
A(m
m²)
0
3000
4000
5000
6000
Pre 5wk 12wkPre 5wk 12wkPre 5wk 12wk
*
§**
Changes in anatomical
Muscle Cross Sectional Area (CT-scanning)
CS
A
(%)
0
90
92
94
96
98
100
102
104
106
108
110
S - CSA %
E - CSA %
K - CSA %
*
Pre 5w 12w
#
Suetta, Aagaard et al, J Appl Physiol 2004
ST ES SR
ST
SR ES
Standard Rehab
Electro Stimulation
Strength Training
ST
SR
ES
Rehabilitation from elective Hip replacement Surgery by use of Strength Training
Changes in maximal muscle strength (isometric MVC)
To
rqu
e (
Nm
)
0
20
40
60
80
100
120
140
160
180
strength-op
elstim-op
kontrol-op
Pre 5w 12w Pre 5w 12w
*
Isometric strength 60°
Suetta et al, J Appl Physiol 2004
To
rqu
e (
Nm
)
0
20
40
60
80
100
120
140
160
strength-op
elstim-op
kontrol-op
#
Pre 5w 12w
RT ES SR resistance electrical standard
training stimulation rehabilitation
12 wk > pre (p<0.05); # 5 wk < pre,12 wk (p<0.05) *
+24%
-22%
Rehabilitation from elective Hip replacement Surgery by use of Strength Training
20
Changes in neuromuscular activity (muscle EMG)
and Rapid Force Capacity (RFD)
Rehabilitation from elective Hip replacement Surgery by use of Strength Training
Heavy-resistance strength training
Concurrent increases in
maximal RFD and neuromuscular activity (iEMG)
in elderly individuals
Training induced changes inexplosive muscle strength (RFD)
Adaptive responses in aged individuals
Häkkinen & Häkkinen 1995 (age 50, 70 yrs, gender F, M)
Häkkinen et al. 1998 (age 40, 60 yrs, gender F, M)
Häkkinen et al. 2001 (age 63 yrs, gender F)
Suetta et al. 2004 (post hip replacement surgery, 60-86 yrs)
Barry et al. 2005 (age 60-79 yrs, gender F, M)
100 Nm
-2500
2500
3000
-3000
-4000
4000
position
Moment
EMG VL
EMG VM
EMG RF
Time (msec)
0 1000 2000 3000 4000 5000
uVolt
uVolt
uVolt
Time (msec)
0 1000 2000 3000 4000 5000
slow concentric contraction
pre training
slow eccentric contraction
pre training
Neural drive m. quadriceps
Aagaard et al., J. Appl. Physiol. 2000
Changes in neuromuscular activity (muscle EMG)
and Rapid Force Capacity (RFD)
Rehabilitation from elective Hip replacement Surgery by use of Strength Training
Heavy-resistance strength training
Concurrent increases in
maximal RFD and neuromuscular activity (iEMG)
in elderly individuals
Training induced changes inexplosive muscle strength (RFD)
Adaptive responses in aged individuals
Häkkinen & Häkkinen 1995 (age 50, 70 yrs, gender F, M)
Häkkinen et al. 1998 (age 40, 60 yrs, gender F, M)
Häkkinen et al. 2001 (age 63 yrs, gender F)
Suetta et al. 2004 (post hip replacement surgery, 60-86 yrs)
Barry et al. 2005 (age 60-79 yrs, gender F, M)
100 Nm
-2500
2500
3000
-3000
-4000
4000
position
Moment
EMG VL
EMG VM
EMG RF
Time (msec)
0 1000 2000 3000 4000 5000
uVolt
uVolt
uVolt
Time (msec)
0 1000 2000 3000 4000 5000
slow concentric contraction
pre training
slow eccentric contraction
pre training
Neural drive m. quadriceps
Aagaard et al., J. Appl. Physiol. 2000
Heavy-resistance strength training
Concurrent increases in
maximal RFD and neuromuscular activity (iEMG)
in elderly individuals
Training induced changes inexplosive muscle strength (RFD)
Adaptive responses in aged individuals
Häkkinen & Häkkinen 1995 (age 50, 70 yrs, gender F, M)
Häkkinen et al. 1998 (age 40, 60 yrs, gender F, M)
Häkkinen et al. 2001 (age 63 yrs, gender F)
Suetta et al. 2004 (post hip replacement surgery, 60-86 yrs)
Barry et al. 2005 (age 60-79 yrs, gender F, M)
100 Nm
-2500
2500
3000
-3000
-4000
4000
position
Moment
EMG VL
EMG VM
EMG RF
Time (msec)
0 1000 2000 3000 4000 5000
uVolt
uVolt
uVolt
Time (msec)
0 1000 2000 3000 4000 5000
slow concentric contraction
pre training
slow eccentric contraction
pre training
Neural drive m. quadriceps
Aagaard et al., J. Appl. Physiol. 2000
Heavy-resistance strength training
Concurrent increases in
maximal RFD and neuromuscular activity (iEMG)
in elderly individuals
Training induced changes inexplosive muscle strength (RFD)
Adaptive responses in aged individuals
Häkkinen & Häkkinen 1995 (age 50, 70 yrs, gender F, M)
Häkkinen et al. 1998 (age 40, 60 yrs, gender F, M)
Häkkinen et al. 2001 (age 63 yrs, gender F)
Suetta et al. 2004 (post hip replacement surgery, 60-86 yrs)
Barry et al. 2005 (age 60-79 yrs, gender F, M)
100 Nm
-2500
2500
3000
-3000
-4000
4000
position
Moment
EMG VL
EMG VM
EMG RF
Time (msec)
0 1000 2000 3000 4000 5000
uVolt
uVolt
uVolt
Time (msec)
0 1000 2000 3000 4000 5000
slow concentric contraction
pre training
slow eccentric contraction
pre training
Neural drive m. quadriceps
Aagaard et al., J. Appl. Physiol. 2000
Changes in neuromuscular activity (muscle EMG)
and Rapid Force Capacity (RFD)
Rehabilitation from elective Hip replacement Surgery by use of Strength Training
Heavy-resistance strength training
Concurrent increases in
maximal RFD and neuromuscular activity (iEMG)
in elderly individuals
Training induced changes inexplosive muscle strength (RFD)
Adaptive responses in aged individuals
Häkkinen & Häkkinen 1995 (age 50, 70 yrs, gender F, M)
Häkkinen et al. 1998 (age 40, 60 yrs, gender F, M)
Häkkinen et al. 2001 (age 63 yrs, gender F)
Suetta et al. 2004 (post hip replacement surgery, 60-86 yrs)
Barry et al. 2005 (age 60-79 yrs, gender F, M)
100 Nm
-2500
2500
3000
-3000
-4000
4000
position
Moment
EMG VL
EMG VM
EMG RF
Time (msec)
0 1000 2000 3000 4000 5000
uVolt
uVolt
uVolt
Time (msec)
0 1000 2000 3000 4000 5000
slow concentric contraction
pre training
slow eccentric contraction
pre training
Neural drive m. quadriceps
Aagaard et al., J. Appl. Physiol. 2000
Heavy-resistance strength training
Concurrent increases in
maximal RFD and neuromuscular activity (iEMG)
in elderly individuals
Training induced changes inexplosive muscle strength (RFD)
Adaptive responses in aged individuals
Häkkinen & Häkkinen 1995 (age 50, 70 yrs, gender F, M)
Häkkinen et al. 1998 (age 40, 60 yrs, gender F, M)
Häkkinen et al. 2001 (age 63 yrs, gender F)
Suetta et al. 2004 (post hip replacement surgery, 60-86 yrs)
Barry et al. 2005 (age 60-79 yrs, gender F, M)
100 Nm
-2500
2500
3000
-3000
-4000
4000
position
Moment
EMG VL
EMG VM
EMG RF
Time (msec)
0 1000 2000 3000 4000 5000
uVolt
uVolt
uVolt
Time (msec)
0 1000 2000 3000 4000 5000
slow concentric contraction
pre training
slow eccentric contraction
pre training
Neural drive m. quadriceps
Aagaard et al., J. Appl. Physiol. 2000
Training induced changes inexplosive muscle strength (RFD)
Adaptive responses in aged individuals
Functional consequences
- enhanced acceleration
- elevated maximal movement velocity
- elevated muscle force & power during
rapid movements
Heavy-resistance strength training
Concurrent increases in
maximal RFD and neuromuscular activity (iEMG)
in elderly individuals
21
Pro
cent
(%)
-15
-10
-5
0
5
10
15
20
S - %
E - %
SR - %
Pro
ce
nt (%
)
0
5
10
15
20
25
30
S - % d i f f
E - % d i f f
SR - % d i f f
Pre 5w 12w Pre 5w 12w
Max 10m walk speed Speed of Chair-rising x 5
*
* $
Changes in Functional Capacity
ST
SR
ES
ST
SR
ES
Suetta, Aagaard, Kjaer et al, JAGS 2004
Rehabilitation from elective Hip replacement Surgery by use of Strength Training
Changes in mechanical muscle function and
functional capacity in response to resistance
training in elderly frail old women (75-88 yrs)
- After fall injury
Beyer et al, Clin Exp Res 2007
22
Females
70-90 yrs
Test
0 6 12
months
Test Test
Training
2 x1 h/w
Control
Test
Nina Beyer 2003
Muscle strength and functional performance
following strength training in elderly fall patients
Nina Beyer 2003
Muscle strength and functional performance
following strength training in elderly fall patients
Maximal quadriceps and hamstring strength Isokinetic knee extension/flexion torque
Knee extension
60 deg/s
Knee flexion
60 deg/s
Months
0 3 6 9 12
To
rqu
e (
Nm
)
0
10
20
30
40
50
60
70
80
90***
**
*** *** ***
Mean ± SE. Change from baseline: **, ***
TG
CG
TG
CG
TG
CG
TG
CG
Beyer et al, Clin Exp Res 2007
23
*** *** ***
Months
0 3 6 9 12
Wa
tts
0
50
60
70
80
90
100
******
***
TG
CG
Average
Mean ± SE. Change from baseline: ***
Maximal leg extension power Nottingham Power Rig
Beyer et al, Clin Exp Res 2007
Chair rise time
Months
0 6 12
Chair
ris
e t
ime
(s)
0
7
8
9
10
11
12
13
14
C 0-12 mths, n=13
T 0-12 mths, n=14
Stair climbing time
Months
0 6 12
Sta
ir c
limbin
g (
s)
0
5
6
7
8
9
C 0-12 mths, n=13
T 0-12 mths, n=13
**
***
******
x 5
Mean ± SE, Change from baseline: **, ***
Functional motor performance rising from chair, stair climbing
TG
TG
CG
CG
Beyer et al, Clin Exp Res 2007
Months
0 3 6 9 12
Sp
ee
d (
m/s
)
0.00
1.00
1.05
1.10
1.15
1.20
1.25
1.30
1.35
1.40
1.45
1.50
1.55
1.60
1.65
Months
0 3 6 9 12
******
***
******
***
Mean ± SE, Change from baseline: ***
Normal Maximal
Functional motor performance level walking: preferred speed and max speed
CG
CG
TG
TG
Beyer et al, Clin Exp Res 2007
24
Walking speed 10 -15%
Stair climbing 20%
Chair rising 20%
Balance score 10 -15%
Maximal leg Power 35%
Knee strength 20 - 25%
Trunk strength 30 - 45%
Handgrip strength 7%
Daily activity
Functional ability
Muscle performance
Beyer et al, Clin Exp Res 2007
Muscle strength and functional performance
following strength training in elderly fall patients
“Träning för äldre”
Utbildningsdag Sjukgymnastdagarna, Göteborg October 4th, 2013
Age-related changes in neuromuscular function
- Effects of strength training
CONLUSIONS and SUMMARY
The age-related loss in muscle mass and the
concurrent decrease in maximal muscle strength,
rapid force capacity (RFD) and power can be
slowed or reversed by training (strength training!)
Likewise, the age-related impairment in neural function
can be effectively compensated by training (strength training)
!! ALSO the case in frail elderly patients !!
CONLUSIONs
25
SUMMARY Effects of strength training on
neuromuscular function and muscle size in the elderly
dynamic muscle strength, isometric muscle strength Frontera 1988, Fiatarone 1990, Häkkinen 1998, Harridge 1999, Suetta 2004, Beyer 2007
muscle power Beyer 2007, De Vos 2005, Caserotti 2008
Rapid force capacity (rate of force development: RFD) Häkkinen 1995 1998 2001, Hortobagyi 2001, Suetta 2004, Barry 2005, Caserotti 2008
Strength and Power
properties
SUMMARY Effects of strength training on
neuromuscular function and muscle size in the elderly
Aagaard, Kjær et al, Scand J Med Sci Sports 2010
dynamic muscle strength, isometric muscle strength Frontera 1988, Fiatarone 1990, Häkkinen 1998, Harridge 1999, Suetta 2004, Beyer 2007
muscle power Beyer 2007, De Vos 2005, Caserotti 2008
Rapid force capacity (rate of force development: RFD) Häkkinen 1995 1998 2001, Hortobagyi 2001, Suetta 2004, Barry 2005, Caserotti 2008
EMG amplitude and rate of EMG rise Häkkinen 1995 1998 2001, Suetta 2004, Barry 2005
maximal motor neuron firing frequency Kamen 1998, Patten 1999, Kamen & Knight 2004
improved force steadiness, enhanced fine motor control Hortobagyi 2001, Tracy 2004, Tracy & Enoka 2006
Neural factors
Strength and Power
properties
Aagaard, Kjær et al, Scand J Med Sci Sports 2010
SUMMARY Effects of strength training on
neuromuscular function and muscle size in the elderly
26
dynamic muscle strength, isometric muscle strength Frontera 1988, Fiatarone 1990, Häkkinen 1998, Harridge 1999, Suetta 2004, Beyer 2007
muscle power Beyer 2007, De Vos 2005, Caserotti 2008
Rapid force capacity (rate of force development: RFD) Häkkinen 1995 1998 2001, Hortobagyi 2001, Suetta 2004, Barry 2005, Caserotti 2008
EMG amplitude and rate of EMG rise Häkkinen 1995 1998 2001, Suetta 2004, Barry 2005
maximal motor neuron firing frequency Kamen 1998, Patten 1999, Kamen & Knight 2004
improved force steadiness, enhanced fine motor control Hortobagyi 2001, Tracy 2004, Tracy & Enoka 2006
single muscle fiber size (fiber CSA), whole muscle size (anatomical CSA)
Frontera 1988, Häkkinen 1998, Harridge 1999, Esmarck 2003, Kryger & Andersen 2007, Suetta 2004 2008
myogenic satellite cell activation MacKey 2007, Petrella 2008
muscle fiber pennation angle, tendon stiffness Reeves 2003, Reeves 2006, Suetta 2008
Muscular factors
Neural factors
Strength and Power
properties
SUMMARY Effects of strength training on
neuromuscular function and muscle size in the elderly
Resistance Training
Adaptive changes in
muscle size and
neuromuscular
function
improved function
in ADL(activities of daily living)
THE OVERALL EFFECT OF STRENGTH TRAINING IN THE ELDERLY?
STRENGTH TRAINING
Acknowledgements
Coworkers at Institute of Sports Science and Clinical Biomechanics, University of
Southern Denmark; Institute of Sports Medicine Copenhagen, University of Copenhagen,
and Department of Physiotherapy, Institute of Neuroscience & Physiology, Sahlgrenska
Academy, Göteborg
Michael Kjær
Charlotte Suetta
Jesper L. Andersen
Peter Magnusson
Lena Hulthén
Christian Couppé
Paolo Caserotti
Lars Hvid
Cecilia Edwén
Ulrik Frandsen
Anders H Larsen
Nina Beyer