Effects of aging on neuromuscular function · 2019-10-04 · Effects of aging on neuromuscular...
Transcript of Effects of aging on neuromuscular function · 2019-10-04 · Effects of aging on neuromuscular...
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Effects of aging on neuromuscular function
Chris J. McNeil Ph.D.
January 31, 2015
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OutlineI. Sarcopenia and dynapenia
II. Motor unit loss
III. Muscle power vs. strength
IV. Fatigability with static vs. dynamic tasks
V. Summary
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Neuromuscular changes with aging‘‘No decline with age is more dramatic or potentially more
functionally significant than the decline in lean body mass…
Why have we not given it more attention? Perhaps it needs a
name derived from the Greek. I’ll suggest a couple:
sarcomalacia or sarcopenia’’ (Rosenberg Am J Clin Nutrit 1989)
Sarcopenia – age-related loss of muscle mass
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Neuromuscular changes with aging• Sarcopenia is often used to refer to age-related
losses of muscle mass and strength
• However, there is a growing body of evidence
that age-related losses in strength are only
weakly associated with losses in muscle mass
Dynapenia – age-related loss of strength and power (Clark & Manini J Gerontol A Biol Sci Med Sci 2008)
– impaired performance of daily activities
– reduced quality of life
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Consequences of sarcopenia/dynapenia
Hunter et al. Sports Med 34:329-348 (2004)
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Causes of sarcopenia/dynapenia
Narici & Maganaris J Anat 208:433-443 (2006)
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Part II:
Motor unit loss
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The motor unit (MU)
• A spinal motor neuron and the muscle fibres it
innervates (Liddell & Sherrington Proc R Soc Lond Ser B 1925)
Adapted from:
MacIntosh BR, Gardiner PF & McComas AJ (2006). Skeletal Muscle: Form and Function, 2nd edn. Human Kinetics,
Champagne, IL.
axon
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Motor unit remodelling
• Motor neurons die in the course of healthy aging
X
XX
• Reinnervation prevents/mitigates a reduction in
muscle mass with each motoneuron lost
– delays associated loss of strength and power
collateral
reinnervation
Adapted from:
Stålberg & Falck. Electroencephalogr Clin Neurophysiol 103:579-598, 1997©1997 Elsevier Science Ireland Ltd.
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Number of motor units in a muscle
• Motor units cannot be counted, only estimated, in
humans
• Decomposition-enhanced spike-triggered
averaging (DE-STA)
– motor unit number estimate (MUNE)
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Subjects
• Examination of three age groups to provide
insight into the time course of neuromuscular
change:
8-13 young men (22-33 years old; mean ≈ 26 y)
8-13 old men (60-69 years old; mean ≈ 65 y)
8-13 very old men (80-91 years old; mean ≈ 84 y)
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• All subjects were healthy and physically active
• These old and very old men represent more of a
“best-case” scenario of aging than is typically
seen in the elderly population
Subjects
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Tibialis anterior MUNE
- MU loss occurs by 7th decade and accelerates with age
McNeil et al. Muscle Nerve 31:461-467 (2005)
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Other muscles
Doherty et al. 1993
Doherty et al. 1993
Dalton et al. 2008
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An influence of physical activity
• Might habitual physical activity play a role?
• Evidence in an animal model that long-term
exercise slows age-related changes to motor
neurons (Kanda & Hashizume Neurosci Res 1998)
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Use it or lose it?
• Data were collected from the tibialis anterior of
“old” (64±3 years) masters runners
Power et al. Med Sci Sports Exercise 42:1644-1650 (2010)
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Masters of their domain
- MU loss is mitigated by chronic activity of the muscle
Power et al. Med Sci Sports Exerc 42:1644-1650 (2010)
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Systemic or specific?
• Does the prophylactic effect of habitual physical
activity extend to other muscles?
• Data were collected from the biceps brachii of the
masters runners as well as young adults and age-
matched “old” adults
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Even masters have their limits
- MU loss is not mitigated in an uninvolved muscle
Power et al. Med Sci Sports Exerc 44:1235-1242 (2012)
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Part III:
Muscle power vs. strength
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Muscle power vs. strength• Majority of research examining the impact of age
on muscle function is focused on static strength
rather than dynamic power
• Unfortunate because:
– most daily tasks are dynamic
– power is affected by age-related losses in both
strength and velocity
Power = torque (τ) × angular velocity (ω)
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Motor unit remodelling
X
XX
• Reinnervation process may cause a shift toward a
slower muscle
– greater impact on muscle power than strength
collateral
reinnervation
Adapted from:
Stålberg & Falck. Electroencephalogr Clin Neurophysiol 103:579-598, 1997©1997 Elsevier Science Ireland Ltd.
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Evoked contractile properties• Intrinsic contractile properties can be assessed
with external stimulation of the nervous system
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Intrinsic slowing of muscle
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Dorsiflexor twitch contraction duration
90.9 98.0 112.4
- contractile speed slows between 7th & 9th decades
McNeil et al. Muscle Nerve 31:461-467 (2005)
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Volitional angular velocity• Measured “isotonically”
– i.e., a fixed (ish) load is moved through a range of
motion as fast as possible
25°
* loads normalized to peak isometric torque
during a maximal voluntary contraction (MVC)
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Dorsiflexor angular velocity
- velocity decreases between 3rd & 7th decades
McNeil et al. J Appl Physiol 102:1962-1968 (2007)
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Dorsiflexor strength
McNeil et al. J Appl Physiol 102:1962-1968 (2007)
- strength decreases between 7th and 9th decades
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Dorsiflexor power
- power decreases between 3rd & 7th decades
McNeil et al. J Appl Physiol 102:1962-1968 (2007)
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Loss of strength vs. power
- power deficits > strength deficits at both ages
McNeil et al. J Appl Physiol 102:1962-1968 (2007)
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Functional relevance of power
http://www.youtube.com/watch?v=T7efWmFSroo
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Part IV:
Fatigability with static vs. dynamic tasks
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Muscle fatigue• Fatigue is highly dependent on task performed
– e.g., reports that fatigue ↑, ↓, or ↔ with age
• Majority of studies involve isometric contractions
and report enhanced muscle endurance with age
– greater metabolic efficiency (ATP production via
aerobic metabolism) (Lanza et al. 2004)
• Greater endurance in the elderly does not fit with
what we observe in real life
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What happens with dynamic tasks?• Results are equivocal when velocity is constrained
(isokinetic contractions)
Baudry et al. Eur J Appl Physiol 100:515-525 (2007)Lanza et al. J Appl Physiol 97:967-975 (2004)
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The importance of velocity
Dalton et al. Exp Gerontol 47:85-92 (2012)
slow (60°/s) isokinetic task
– similar fatigue
moderate (180°/s) isokinetic task
– greater fatigue in old
unconstrained velocity task
– greater fatigue in old
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McNeil et al. J Gerontol A Biol Sci Med Sci 62:M624-629 (2007)
Dorsiflexor fatigue
- fatigue is increased in the 9th decade
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Part V:
Summary
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Summary• Motor units are lost with healthy aging but
habitual activity can have a protective effect
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Summary• Contractile slowing contributes to power losses in
excess of any strength losses
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Summary• Fatigability increases with age during tasks most
similar to activities of daily living
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A final (sobering) thought• These data represent the best-case scenario of
aging and so the age-related losses in power and
endurance in the general population are certain to
be underestimated
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Thank you
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Extra slides
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Simple analogy of the technique
• Suppose you wanted to estimate the number of
potatoes in a basket
http://commons.wikimedia.org/wiki/File:Potatoes_in_markets.jpg
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Simple analogy of the technique
STEP 1
• Get the mass of the basket of potatoes (less the
mass of the empty basket)
20kg
STEP 2:
• Take a sample of individual potatoes (e.g., 20) and
find the mean mass
80g
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Simple analogy of the technique
STEP 3
• Divide total mass by mean mass of a single potato
to an estimate of the number in the basket
𝑒𝑠𝑡𝑖𝑚𝑎𝑡𝑒 =20𝑘𝑔
0.08𝑘𝑔
𝑒𝑠𝑡𝑖𝑚𝑎𝑡𝑒 = 250 potatoes
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The M-potential / M-wave / CMAP• Electrical (EMG) response of a muscle to
external stimulation
60mA
80mA
100mA
120mA, 140mA
• When size does not increase despite an increase
in current, all functional motor units of a muscle
have been activated
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Signal decompositionRaw surface EMG signal split into single
surface motor unit potentials (S-MUPs)
(the individual potatoes)
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Motor unit number estimate
6.4mV
21μV
𝑀𝑈𝑁𝐸 =𝑚𝑎𝑥𝑖𝑚𝑎𝑙 𝑀‐ 𝑝𝑜𝑡𝑒𝑛𝑡𝑖𝑎𝑙
𝑚𝑒𝑎𝑛 𝑆‐𝑀𝑈𝑃
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6.4mV
21μV
𝑀𝑈𝑁𝐸 =6400μV
21μV= 304
Motor unit number estimate
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Imaged subjects in a 3 Tesla magnet
24 year old 65 year old 80 year old
Muscle mass
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Anterior compartment muscle mass
14.3 14.6 12.9
- muscle mass is preserved with age
McNeil et al. J Appl Physiol 102:1962-1968 (2007)
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Strength & power normalized to muscle mass
McNeil et al. J Appl Physiol 102(5):1962-1968 (2007)
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McNeil et al. J Appl Physiol 102(5):1962-1968 (2007)
- decrease in muscle quality not quantity is most responsible
Strength & power normalized to muscle mass
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Summary• Contractile slowing contributes to power losses in
excess of any strength losses
• Deficits of strength and power without a loss of
muscle mass indicate that muscle quality is more
influential than muscle quantity
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Contradictory evidence
• However, when matched for strength, young
adults are still more fatigable than old adults
Hunter et al. J Appl Physiol 99:890-897, 2005©2005 the American Physiological Society
20% MVC of elbow flexors
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Contradictory evidence
• When blood flow is occluded, young adults are
still more fatigable than old adults
Chung et al. J Appl Physiol 103:1628-1635, 2007©2007 the American Physiological Society
Intermittent MVCs (5s on, 5s off)
of dorsiflexors
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Neuromuscular changes with aging• Sarcopenia is often used to refer to age-related
losses of muscle mass and strength
• However, there is a growing body of evidence
that age-related losses in strength are only
weakly associated with losses in muscle mass
Dynapenia – age-related loss of strength and power (Clark & Manini J Gerontol A Biol Sci Med Sci 2008)
– impaired performance of daily activities
– reduced quality of life
– financial burden
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The cost of sarcopenia/dynapenia• In the US in 2000, an estimated $18.5 billion was
spent on the direct healthcare costs attributable to
the age-related loss of muscle mass, strength and
power (Janssen et al. J Am Geriatr Soc 2004)
• In contrast, osteoporotic fractures – an event
synonymous with debilitation and a drain on
healthcare resources – had an estimated cost of
$13.8 billion in 1995 (Ray et al. J Bone Miner Res 1997)