Fit and Fabulous Over 50

Becky Behling, MS, cPT

January 19, 2014

What happens in older age?

“What do you expect, you are getting older…” “For your age….” REMEMBER: What often happens during

aging is “common, but not normal...” You are in the fight OF your life and FOR

your life! Consider how media presents older adults Consider what and how companies market

Administration on Aging, 2005

Current world population of people age 65-84 is estimated to be 605 million

Expected to reach almost 2 billion by 2050 By 2030, adults aged 65-84 will account for 20% of US

population From 1995, people 85+ years of age will increase by

56% This dramatic increase in elders is unprecedented in the

history of the world Attributed to social, medical, technological advances

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In the United States....

people age 65 and older are the most rapidly growing age group

this trend expected to continue for 20+ years older Americans are the least physically

active of any age group

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Growing older can be costly Older Americans generate the highest expenditures

for medical care in a 2009 study, “Buddy, Can You Spare a Job?”,

researchers reported “the average retired couple will need to spend more than $230,000 on health care alone during retirement” (statefarm.com, goodneighbor magazine, p 13)

Chronic conditions are prevalent and many suffer from more than one condition

Chronic conditions restrict activity Indicated by more than 25% people age 65-74

Physically dependent older adults incur costs 8x higher in their last years than people who “age successfully”

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Aging is a dynamic and progressive process

Deterioration of physical functions: muscle, bone, cardiovascular, pulmonary, skin,

resiliency Diminishment in brain:

volumes of white matter, gray matter, hippocampus, amygdala, and cortices (prefrontal, temporal, parietal, suboccipital)

Decline in cognitive function: information processing speed, reasoning,

attention, multiple memory formation

Health and fitness are closely related

Sedentary lifestyle increases risk for: Cardiovascular disease including coronary heart disease, hypertension,

peripheral vascular disease, adverse blood lipid profiles, claudication, thromboembolic stroke, congestive heart failure, syncope

Obesity (BMI > 30) Metabolic syndrome (3 of 5 risk factors present: blood sugar/high fasting

glucose levels; high blood pressure; low HDL, high triglycerides, waist size > 40” in men, 35” in women

Some cancers, e.g. breast, prostate, colon, lung, endometrial Type 2 diabetes Hypertension COPD Constipation

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Socioemotional aspects of physical inactivity

Depression Anxiety Dementia Managing, even delaying, cognitive impairment

cognitive functions include memory, association, comparison, abstract reasoning, spatial ability, synthesis, executive control

processes that support cognition include attention, resource allocation, working memory, processing speed, motor output, perceptual processes

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The problem:

Too little muscle Approximately 5-7 pounds lost per decade

Too much fat Body weight and body composition change with

aging Too low metabolic rate

Approximately 2-4% reduction per decade (Westcott, 2012 webinar, Human Kinetics)

Sarcopenia: Declining Skeletal Muscle The loss of muscle mass

one of the most persistent and compelling evidences of aging, especially in sedentary elders

Involves the loss and atrophy of muscle fiber number, distribution, and size (cross-sectional area)

Decline begins in the 5th decade and accelerates after age 60

(Macaluso et.al., 2004, Deschenes, 2004, Tarpenning et.al., 2004, Pansarasa et.al., 2002)

Changes To Muscle Fibers

Atrophy of and reduction in Type I and Type II muscle fibers (Hikida et.al., 2000, Hakkinen et.al., 2001)

Type II fibers are especially vulnerable to atrophy and/or loss “fast twitch”, high glycolytic, fast fatigue

Reinnervation may result in myofibers receiving different neural input Myofibers receive conflicting signals which contradicts

the action of the original fiber type Result may be coexpression of fiber type

(Spirduso et.al., 2005)

What’s so special about Type II fibers?

Fiber characteristics include: Short contraction time Ability to produce high tension Production of explosive force Needed for Activities of Daily Living (ADL)

Presence of Sarcopenia (muscle wasting)

in MRI Cross Section of Thigh

25 yr old male 65 yr old male

~40% total mass lost between ages 24-80; total muscle

cross-sectional area peaks at age 24 (Spirduso et.al., 2005)

Osteopenia/osteoporosis DXA scan a "T score" and a "Z score” The risk for fracture doubles with every standard deviation below

normal Z score compares the patient's BMD to the average of a person of the same age

and sex T score compares the BMD to a healthy 30-year-old of the same sex

Scores are measured in standard deviations above or below normal if T score is -1.0, BMD is 1.0 standard deviations below a healthy 30-year-old of

the same sex the lower the bone mineral density, the lower the T score or Z score and the

higher the risk of fracture a T score of -2.0 has an approximately twofold increased risk of fracture as

compared to someone with a T score of -1.0 Osteopenia T score ranges are -1.0 to -2.5 Osteoporosis T scores are -2.5 and greater

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http://s3.hubimg.com/u/3177750_f520.jpg15

Muscle Strength Defined as the maximal force that a muscle or

muscle group can generate at a specified velocity (Baechle, 1994)

Strength is required to sustain activities of daily living (ADLs) such as cooking, cleaning, yard work, food shopping and preparation, and care of self and others

Strength enables individuals to participate in hobbies, recreation, and social activities

Positive correlations between muscle strength and functional status of older adults

Power

Power is considered to be the time rate of work, that is:

Work = Force x Distance and Power = Work/Time (Baechle, 1994) Power provides the explosive ability to

execute rapid movement such as quickly correcting body position, lifting heavy objects, or moving to catch something that is falling

Age Brings Declines in Power

In men, power declines at approximately 30% or more from age 40 onward (Huonker et.al., 2002)

Declines are more pronounced in women, especially with movement requiring more complexity and explosive power (Anton et.al., 2004)

Power declines at a rate of 10% more per decade than does strength; magnitude of decline is slightly less in individuals who continue to train for power in high intensity activity such as cycling

(Spirduso et.al., 2005)

Age Brings Changes to the Motor Unit

A motor unit is comprised of a motor neuron and all the muscle fibers it innervates

There is a decrease in the number of motor neurons in spinal cord

Subsequent reinnervation due to axonal sprouting from Type I, “slow twitch”, fiber increases the size of individual motor units

There are corresponding increases in innervation ratio (Latash, 1998)

Motor Unit and Myofiber Changescopyright © 2004, Regents of the University of California

Lifestyle Concerns

Reduction in Activities of Daily Living (ADLs) Posture control diminishes due to atrophy of Type I

fibers Increase in frailty increases risk of bone fractures Greater need for medical care Loss of power due to reduction in Type II fibers

increases risk of falling Elders may not have power reserves to correct imbalances

Other Factors Contributing to Muscle Decline Reduced ACh released at terminal neurons

(Kouvoumdjian, 1993) Increase in catabolic agents such as interleukin-6

enhances wasting rate (Deschenes, 2004) Reduction in anabolic hormones, specifically

testosterone, growth hormone, and insulin-like growth factor-1 (AGRC Online, 2004)

Decrease in mitochondria number and size results in fewer energy resources (Huonker et.al., 2002)

Decrease in capillarization, Type II fiber size, and oxidative capacity (Proctor et.al., 1995)

Get physically active, stay physically active!

5 basic components of fitness: muscle strength, muscle stamina, cardiovascular stamina, body composition, flexibility, neuromotor (ADLs)

Other components: coordination, agility, power, balance (static, dynamic), speed

Physical activity

Makes deposits in your physical IRA by improving: Resilience Mental Spiritual Emotional Social Health Longevity Quality of life

Muscles do not know age: they know use and disuse

Age is NOT a deterrent to exercise Exercise for health benefits can be attained

with lower levels of activity done persistently over time at any age

Muscle’s “longevity profile” improves by reversing expressions associated with (Melov et al., 2007)

Become physically active!

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Age is not a barrier to resistance training

Westcott et.al. John Knox Village Campus, Orange City, FL 19 older adults average age 88.5 years 14 women, 5 men 14 week, training 2x/week, 6 exercises

performed on 5 Nautilus weight stack machines sessions about 20 minutes long slow movement: 2 seconds to lift, 4 seconds

to lower through fullest possible range many participants were in wheelchairs and

required assistance to transfer on/off equipment26

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John Knox Village Results

increased lean/muscle weight 4 pounds decreased body fat 3 pounds increased leg strength >80% increased upper body strength almost 40% improved shoulder ROM ~10% enhanced hip ROM >505 improved functional abilities/FIM Score ~14% increased mobility distance more than 70% reduced fall rate ~40% all but one (double amputee) reduced wheelchair use one woman was able to return home

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Westcott et.al. again...

The Fountains of Boca Ciega Ba, St. Petersburg, FL, retirement community

45 women, 19 men, average age 84.5 years randomly assigned to control/no exercise,

cardiovascular training (CT), or strength training (ST) 16 weeks

ST trained 2x/week at 75% 1 RM, 1 set 8-12 repetitions on 6 different Kaiser machines; increased weight load 5% when 12 repetitions completed with proper form after 3-5 consecutive sessions

CT walked an average of 2x/week at individual intensity set by 880 yard walk pre-assessment 28

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Another study of older adults

All volunteers: assessed for functional ability pre- and post-

intervention with AAHPERD Assessment for Adults of Age 60

1 RM strength assessment joint flexibility measured with goniometer health knowledge using Fast-Simons Senior Adult

Health Knowledge Test

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ResultsParameter Control Strength Traning Cardiovascular

Training

Strength +12% +33% +12%

Coordination +13% +18 +13%

Agility -21% +14 +9%

Endurance -6% +7 +6%

Flexibility +2% +10 +11%

Health knowledge

+16% +13 +15%

How challenging? Modified Borg Scale for evaluating

exercise intensity Known as “perceived exertion” and is

referenced in the ACSM/AHA recommendations. Sitting is 0 and all-out effort is 10

For aerobics, moderate intensity activity is 5-6 and produces noticeable

increases in heart rate and breathing; vigorous intensity activity is a 7-8 and

produces large increases in heart rate and breathing

For strength training, the level of effort should be moderate to high. Moderate

intensity effort is 5-6 and high intensity effort is 7-8.

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Resistance Training and Muscle Changes

Affects body composition ~1-2 kg fat loss with 1-2 kg increase in muscle mass

Lowers incidence of chronic disease s/a diabetes, stroke, arthritis, CHD, pulmonary disorders

Triggers fat oxidation after RT (Donnelly et.al., 2003)

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What to do NOW (ACSM, 2011)

• Train each major muscle group 2 or 3 days/week using a variety of exercises and equipment.

• Very light or light intensity is best for older persons or previously sedentary adults starting exercise.

• 2-4 sets of each exercise helps improve strength and power.

• For each exercise:• 8-12 repetitions improve strength and power• 10-15 repetitions improve strength in middle-age and older

persons starting exercise• 15-20 repetitions improve muscular endurance.

• Wait at least 48 hours between resistance training sessions.

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Specifics

Multi-joint exercises are better Variety will enhance adherence (Single sets?

Multiple sets? Multiple exercises? Do them all!) Best strength gains occur at 60% RM and greater Some options

Chest press, rows, squats, lunges, lat pull downs, shoulder presses, back extensions, abs, knee extensions, knee curls, heel lifts, bicep curls, triceps extensions, and others

At home - push ups at kitchen counter, squats/lunges, heel lifts, “mountain climbers” with a chair

Vary sequence, speed, timing, height, distance

Implications for Physical Activity Programming

For older adults: Longer time to see results Sensible progression and overload Inclusion of both aerobic and anaerobic activity

(ACSM, 1998) Social, mental, spiritual as well as physical

components should be included (Markula, et.al., 2001)

Aerobic Activity Declines in aerobic capacity in men and women at about

5 ml/kg/min each decade Light intensity activity such as brisk walking can slow

decline significantly Higher intensities = greater gains Results include resistance to CHD, diabetes,

osteoporosis, obesity, some forms of cancer, enhanced muscle power, reduction in fall incidences, improved recovery time from injuries

Potential to delay loss of independence by as much as 20 years

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What to do NOW (ACSM, 2011)• Adults should get at least 150 minutes per week of

moderate-intensity exercise. • Exercise recommendations can be met through 30-60

minutes of moderate intensity exercise (five days per week) OR 20-60 minutes of vigorous intensity exercise (three days per week).

• One continuous session and multiple shorter sessions (of at least 10 minutes) are both acceptable to accumulate desired amount of daily exercise.  

• Gradual progression of exercise time, frequency and intensity is recommended for best adherence and least injury risk.

• People unable to meet these minimums can still benefit from some activity. 37

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Also Flexibility Training...

Adults should do flexibility exercises at least two or three days each week to improve range of motion.

Each stretch should be held for 10-30 seconds to the point of tightness or slight discomfort.

Repeat each stretch two to four times, accumulating 60 seconds per stretch.

Static, dynamic, ballistic and PNF stretches are all effective.

Flexibility exercise is most effective when the muscle is warm. Try light aerobic activity or a hot bath to warm the muscles before stretching.

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And Neuromotor Training

Neuromotor exercise (sometimes called “functional fitness training”) is recommended for two or three days per week.

Exercises should involve motor skills (balance, agility, coordination and gait), proprioceptive exercise training and multifaceted activities (Feldenkrais Method, tai chi, yoga, sensible Pilates, qigong, dance, hiking, martial arts) to improve physical function and prevent falls in older adults.

20-30 minutes per day is appropriate for neuromotor exercise.

Posit Science HQ, Dr. Michael Merzenich, Soft-Wired39

Health and fitness are closely related

Sedentary lifestyle increases risk for: Cardiovascular disease including coronary heart disease, hypertension,

peripheral vascular disease, adverse blood lipid profiles, claudication, thromboembolic stroke, congestive heart failure, syncope

Obesity (BMI > 30) Metabolic syndrome (3 of 5 risk factors present: blood sugar/high fasting

glucose levels; high blood pressure; low HDL, high triglycerides, waist size > 40” in men, 35” in women

Some cancers, e.g. breast, prostate, colon, lung, endometrial Type 2 diabetes Hypertension COPD Constipation

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Socioemotional aspects of physical inactivity

Depression Anxiety Dementia Managing, even delaying, cognitive impairment

cognitive functions include memory, association, comparison, abstract reasoning, spatial ability, synthesis, executive control

processes that support cognition include attention, resource allocation, working memory, processing speed, motor output, perceptual processes

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Your Brain On Exercise

Enhances angiogenesis and neurogenesis (Proctor et.al., 1995, Spirduso et.al., 2005)

Additional thoughts Increase activity through day Use time chart to establish amounts of time you are

active and sedentary Chart two typical weekdays Chart one typical weekend day

Be active during sedentary times Walk when talking on the phone Walk/bike instead of driving Additions to walking

speed, forward/backward/sideways locomotor skills (walk, run, skip, gallop, slide, leap,

hop, jump)

Elders Benefit from Both Aerobic and Anaerobic ConditioningWorld Record Sprinter

Margaret Peters, age 70

Ed Whitlock Marathon Record Holder

A 72-year-old Canadian man has become the first person over 70 to run a marathon in under three hours.  Ed Whitlock finished the Scotiabank Toronto Waterfront Marathon in two hours, 59 minutes and 10 seconds.  His participation in the event had been in doubt following a fall while out walking a few days before, reports the Toronto Star.  But Mr Whitlock was determined to run the race.  He said of his performance: "It's a kind of cheap version of Roger Bannister's four-minute mile.  I feel pretty awful right now." (flatrock.org.nz)

Karate Grandma Gussie Pate A decade ago, septuagenarian

Augusta "Gussie" Pate was in downtown Paterson when she walked back to where she had parked nd saw about 8 youths leaning all over her car.  "She walked up to those kids and she said, 'Hey, you better get off that car if you know what's good for you.  I have a black belt in karate!'" said her daughter, Cheryl Chapman of Millburn.  Funny thing was, Mrs Pate wasn't kidding.  She really did have a black belt.  She earned it when she was 70 years old at a Midland Park academy where she was known as the "Karate Grandma."  Funeral services for Mrs Pate, who died Monday at her Springfield home, were held yesterday at the Bradley, Smith & Smith Funeral Home in Springfield.  She was 86. (flatrock.org.nz )

References AGRC Online Curriculum , University of California-San Fransisco, Academic Geriatric Resource Center, December, 22,

2004; http://ucsfagrc.org American College of Sports Medicine, Position Statement, 1998 Anton MM, Spirduso WW, Tanaka H, “Age-related declines in anaerobic muscular performance: weightlifting and

powerlifting”, Med Sci Sports Exerc. 2004 Jan;36(1):143-7 Baechle TR, Essentials of Strength Training and Conditioning, 1994, Human Kinetics, Champaign, IL Bonnefov M, Constans T, Ferry M, “Influence of nutrition and physical activity on muscle in the very elderly”, Presse Med.

2000 Dec 16;29(39):2177-82 Deschenes MR, “Effects of aging on muscle fibre type and size”, Sports Med.2004;34(12):809-24 Grimby G, “Muscle performance and structure in the elderly as studied cross-sectionally and longitudinally”, J Gerontol A

BiolSci Med Sci 1995 Nov;50 Spec No:17-22 Hakkinen K, Kraemer WJ, Newton RU, Alen M, “Changes in electromyographic activity, muscle fibre and force production

characteristics during heavy resistance/power strength training in middle-aged and older men and women”, Acta Physiol Scand: 2001 Jan;171(1):51-62

Hikida RS, Staron RS, Hagerman FC, Walsh S, Kaiser E, Shell S, Hervey S, “Effects of high -intensity resistance training on untrained older men. II. Muscle fiber characteristics and nucleocytoplasmic relationships”, J Gerontol A Biol Sci Med Sci. 2000 Jul;55(7):B347-54

Hortobagvi T, Zheng D, Weidner M, Lambert NJ, Westbrook S, Houmard JA, “The influence of aging on muscle strength and muscle fiber characteristics with special reference to eccentric strength”, J Gerentol A Biol Sci Med Sci, 1995 Nov;50(6):B399-406

Hruda KV, Hicks AL, McCartney N, “Training for muscle power in older adults: effects on functional abilities”, Can J Appl Physiol, 2003 Apr;28(2):178-89

Huonker M, Schmidt-Trucksass A, Heiss HW, Keul J, “Effects of physical training and age-induced structural and functional changes in cardiovascular system and skeletal muscles”, Z Gerontol Geriatr. 2002 Apr;35(2):151-6

Kenny AM, Dawson L, Kleppinger A, Iannuzzi-Sucich M, and Judge JO, “Prevalence of Sarcopenia and Predictors of Skeletal Muscle Mass in Nonobese Women Who Are Long-Term Users of Estrogen-Replacement Therapy”, J Gerentology Series A: Biological Sciences and Medical Sciences 58:M436-440 (2003)

Kouvoumdjian JA, “Neuromuscular abnormalities in disuse, ageing and cachexia”, Arq Neuropsiquiatr. 1993 Sep;51(3):299-306

Latash ML, Neurophysiological Basis of Movement, Human Kinetics, 1998, page 43 Macaluso A, De Vito G, “Muscle strength, power and adaptations to resistance training in older people”, Eur J appl Physiol.

2004 Apr;91(4):450-72. Epub 2003 Nov 25 Markula, P, Bevan CG, Denison J, “Qualitative Research and Aging and Physical Activity: Multiple Ways of Knowing”, J

Aging and Physical Activity, 2001, 9, 245-264 Pansarasa O, Felzani G, Vecchiet J, Marzatico F, “Antioxidant pathways in human aged skeletal muscle: relationship with

the distribution of type II fibers”, Exp Gerentolo. 2002 Aug-Sep;37(8-9): 1069-75 Proctor DN, Sinning WE, Wajro JM, Sieck GC, Lemon PW, “Oxidative capacity of human muscle fiber types: effects of age

and training status”, J Appl Physiol. 1995 Jun;78(6):2033-8 Shephard, RJ, Aging, Physical Activity, and Health, Human Kinetics, 1997 Singh MA, Ding W, Manfredi TJ, Solares GS, O’Neill EF, Clements KM, Ryan ND, Kehavias JJ, Fielding RA, Evans WJ,

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Westcott W and Simons B, “Strength Training Benefits Older Participants”, Sept 2006, http://www.athleticbusiness.com/articles/article.aspx?articleid=3194&zoneid=7