Strength Balance and Function in the Elderly - University of Virginia

Making our Community a Better Place to Age Making our Community a Better Place to Age –– April 13, 2007 April 13, 2007

Strength Balance and Function inthe Elderly

Chris Ingersoll, PhDD. Casey Kerrigan, MD

Phil Rowland, BSJason Rutkowski, MSArthur Weltman, PhD

Institute on Aging, General Clinical Research Center, Institute on Aging, General Clinical Research Center, Kinesiology, Physical Medicine and RehabilitationKinesiology, Physical Medicine and Rehabilitation

University of VirginiaUniversity of Virginia

ACACACAC


Introduction

• Maintaining independent living and high quality oflife are important for the elderly

• Compelling evidence exists regarding the benefits ofphysical activity programs for the elderly

• However, information regarding optimized programsintegrating strength, balance and function for theelderly is lacking


“Every day you get older. It’s the law”Sundance Kid to Butch Cassidy


Sarcopenia

Age related loss of skeletalmuscle mass


Sarcopenia

• Reduced protein reserves• Decreased strength and functional

capacity– Frailty, Falls

• Reduced aerobic capacity• Reduced energy requirements


Sarcopenia• Reduced levels of physical activity• Loss of motor units (aging CNS)• Reduced rate of muscle protein

synthesis– changing endocrine function (testosterone,

estrogen, growth hormone)• Increased dietary protein needs


SarcopeniaSarcopenia

Basal Metabolic Rate

Basal Metabolic Rate

StrengthStrength V O2max

V O2max

ActivityActivity

Energy NeedsEnergy Needs

Bone DensityBone Density

Body FatBody FatOsteoporosisOsteoporosis

FrailtyFrailty


VO2max of sedentary 75 year old womancompared to O2 cost of activities

0 0.25 0.5 0.75 1 1.25 1.5 1.75 2 2.25 2.5

Walk (2.5 mph)

Climb Stairs

Cleaning

Run (6.5 mph)

VO2max

Oxygen consumption (L/min)Oxygen consumption (L/min)


Age-related changes in thighcross-sectional area

21 year old woman21 year old woman

63 year old woman63 year old woman


Impaired StrengthInability to lift 4.5 kg

0

10

20

30

40

50

60

70

Men

Women

Jette, Am. J. Public Health, 71, 1981Jette, Am. J. Public Health, 71, 1981

55-65 65-75 75-85 55-65 65-75 75-85

%%


Death Rates According to IndividualPerformance Tests—Age and Sex Adjusted

Walk Chair Stands Standing Balance% Distribution 5 23 25 26 22 22 19 20 20 19 10 15 13 14 49

0 1 2 3 4Test Category 0 1 2 3 4 0 1 2 3 4


Aerobic Exercise and AgingAerobic Exercise and Aging: Does aging effect: Does aging effectthe adaptation to aerobic exercise training?the adaptation to aerobic exercise training?


OLD YOUNG0

10

20

30

40

50

60

Pre-Training

Post-Training

VO

VO

2max

2max

(ml

(ml ••

kgkg-1-1

•• min

min

-1-1))

Old (60-70)Old (60-70) Young (20-30)Young (20-30)


20100

OLD

YOUNG

% Change in VO2 max

(age 20-30)

(age 60-70)

Older men and women experience a greaterOlder men and women experience a greaterrelative increase in aerobic capacity as a resultrelative increase in aerobic capacity as a result

of 12 weeks of aerobic exercise trainingof 12 weeks of aerobic exercise training

Meredith, CN, et al. Peripheral effects of endurance training in young and old subjects. J ApplPhysiol 66(6):2844-2849, 1989.


Resistance ExerciseResistance Exercise


EXTENSORS FLEXORS

0

10

20

30

40

50

PRE-TRAINING

MID-TRAINING

POST-TRAINING

Extensors FlexorsExtensors Flexors

1 RM1 RM

**

**

****

Frontera, WR, et al Strength conditioning in older men: Skeletal musclefunction and mass. J Appl Physiol 64:1038-1044, 1988.


P r e P o s t

0

1000

2000

ControlExercise

Pre TrainingPre Training Post TrainingPost Training

Activity

(kcal/week)

Activity

(kcal/week)


In very old nursing homeIn very old nursing homeresidents, 10 weeks ofresidents, 10 weeks ofprogressive resistanceprogressive resistanceexercise trainingexercise training

••Increased walkingIncreased walkingspeedspeed

••Increased stair climbingIncreased stair climbingabilityability

••Increased spontaneousIncreased spontaneousactivityactivity

••Decrease in depressiveDecrease in depressivesymptomssymptoms


The Effects of an Aggressive Balance Programon Strength, Balance and Function

24.625.3BMI

71.773.3Age

Control GroupBalance Group


Strength(NM)

0

20

40

60

80

100

120

140

160

180

Flex Ext

Control

Balance

0

20

40

60

80

100

120

Flex Ext

TrunkTrunk KneeKnee


Balance

50

55

60

65

70

75

80

85

90

Path Length (cm)

Control

Balance


Function

15

15.5

16

Time

(seconds)

Control

Balance

1980

2000

2020

2040

Distance (feet)

12

14

16

18

Time (seconds)

30 m Walk30 m Walk

6-min walk6-min walkSit to StandSit to Stand 5 times 5 times


Helen Zechmeister, Age 81, Weight LifterHelen Zechmeister, Age 81, Weight Lifter


Woody BrownWoody Brown

Age 83Age 83

SurferSurfer


John Turner:John Turner:

Age 67Age 67

Weight LifterWeight Lifter

Strength Balance and Function in the Elderly - University of Virginia

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