Resistance Training for the Elderly: Part 2


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Should the Elderly Lift Heavy Weights? Part 2

This series focuses on a number of myths we often hear relating to physiotherapy and exercise. One such myth is that the elderly should not lift heavy weights - just stick to walking!? Well if our above image hasn't blown your mind yet, we plan to explore the science behind the myth of ageing and strength loss. But be fair warned, this blog has a lot of dangerous words (mostly in Latin) which if used incorrectly, could fire up a few arguments with your fellow practitioner. So if you like a saucy read, dig in.

"If you only do one type of exercise after the age of 60 it should almost certainly be resistance training!"

Muscular changes in old age

  • Increased muscle co-activation

There is mixed evidence as to whether or not the elderly lose strength as a consequence of reduced capacities to activate their muscles. Some studies show no decline in this parameter while others do. Perhaps the disparate results reflect differences in the frailty of the subjects chosen in each of the studies?

  • Reduced motor control, proprioception and balance 
    • This increases falls risk and reduces the steadiness of muscle force (fine motor control, think doing up buttons, using a smartphone etc.)

The elderly are more likely to trip, have a reduced capacity to sense imbalance and have a reduced capacity to rapidly correct imbalance. Fall risk increases simultaneously with reduced bone mineral density (BMD) and therefore also increases fracture risk. The control of the motor system declines with age. Changes in the vestibular apparatus and to proprioception create problems sensing losses of equilibrium (balance) while the reduction in muscle power reduces one’s ability to make the relatively rapid corrections that are necessary to stay upright. Falling on osteoporotic bones is clearly a fracture hazard and hip fractures greatly increase risk of all-cause mortality (1, 2, 3, 4)!

Why do resistance training?

Loss of strength and power has a large impact on activities of daily living. Unfortunately, endurance exercises (prolonged walking, jogging, swimming etc.) are often performed instead of heavy resistance training. This is a huge mistake!!! Other forms of exercise do not prevent muscle wasting. Resistance training can increase functional capacity, even in the very old. If you only do one type of exercise after the age of 60 it should almost certainly be resistance training! Of course doing a broader spectrum of activities would be better for your health. But if you had to make a choice of one single type of training, it should be lifting heavy things. This bold statement is justified on the basis that your endurance or aerobic power is of little use once you are no longer strong enough to get up off a chair! Furthermore, studies on masters athletes in a range of sports reveal that running, cycling and swimming have little to no effect on sarcopenia with advancing age. Lastly, there is a wealth of evidence that functional capacity can be improved, even in 90+ year olds, as a consequence of resistance training.

Here are a few reasons to prioritise strength training:

  • Increase power
  • Increase endurance
  • Decrease insulin resistance
  • Reduce total & intra-abdominal fat
  • Increase resting metabolic rate in men
  • Reduce the loss of BMD with age (reducing fracture risk)
  • Reduce fall risk factors
  • Reduce pain in osteoarthritis of the knee (more info here, here, and here)
  • Reduce incidence of psychosocial issues (depression, anxiety etc.), even more so than GP care
    • There's an increased incidence of depression with old age (perhaps due to loss of independence, socialising and physical capacity?)
       

Skeletal muscle is really forgiving. We can neglect it for 40-70 years of adulthood and it still responds positively to a training stimulus. Furthermore, it remains so adaptable that 2-3 months of resistance training can reverse 20 years worth of decline! Unfortunately other tissues, such as bone, are not so forgiving. These require more constant attention across the life-span.

The next part in the series looks at specific ways to train - Resistance Training in the Elderly - Part 3


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References:
1. Evans, J. G., Prudham, D., & Wandless, I. (1979). A prospective study of fractured proximal femur: incidence and outcome. Public Health, 93(4), 235-241.
2. Hu, F., Jiang, C., Shen, J., Tang, P., & Wang, Y. (2012). Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury, 43(6), 676-685. doi: 10.1016/j.injury.2011.05.017
3. Ricci, G., Longaray, M. P., Gonçalves, R. Z., Neto, A. d. S. U., Manente, M., & Barbosa, L. B. H. (2012). EVALUATION OF THE MORTALITY RATE ONE YEAR AFTER HIP FRACTURE AND FACTORS RELATING TO DIMINISHED SURVIVAL AMONG ELDERLY PEOPLE. Revista Brasileira de Ortopedia (English Edition), 47(3), 304-309. doi: https://doi.org/10.1016/S2255-4971(15)30103-8
4. Swantek, S. S., & Goldstein, M. Z. (2000). Practical geriatrics: age and gender differences of patients with hip fracture and depression. Psychiatr Serv, 51(12), 1501-1503. doi: 10.1176/appi.ps.51.12.1501



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