Avoiding the F-word: frailty

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Osteoporosis might be a household word, but hands up who’s heard of sarcopenia? Meaning muscle loss, sarcopenia is like the ugly sister of thinning bones: together they work to make us frail as we age. Although we’re told to keep our bones strong from the teenage years onwards to avoid broken bones in later life, health messages about maintaining muscle are about as loud as a whisper. But it’s often when muscles lose power and strength that we fall over and snap a bone.

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BBC – BBC Radio 4 Programmes – Frontiers, Muscle Wastage

Synopsis

Episode image for Muscle Wastage

 

We’re all familiar by now with being told to “use it or lose it” when it comes to certain aspects of our health and bodies, and never more so than for muscles.

But in this edition of Frontiers, Vivienne Parry hears how new research in to muscle wastage is turning the accepted view on its head.

Startling results from a large-scale study have seen elderly peoples’ muscles completely rebuilt through diet and exercise.

To listen to this program, please click here.

 

Doctors Seek New Ways to Treat Loss of Muscle From Aging

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While an interesting article by the New York Times, I feel that more could have been said about a persons individual ability to counter the effects of sarcopenia by incorporating a strength training program into their daily routine.

Remember an ounce of prevention, is always going to be worth a pound of cure, and with our skeletal muscle we have an amazing opportunity to counter the impact of sarcopenia and live a stronger more robust  quality of life.

An outcome that has health benefits that go way beyond sarcopenia itself. 

 

Exploring the anatomy and physiology of ageing: Part 10 – Muscles and bone | Practice | Nursing Times

1 December, 2008

AUTHORS
John Knight, PhD, BSc; Yamni Nigam, PhD, MSc, BSc; both lecturers in biomedical science, School of Health Science, Swansea University.

Knight, J. (2008) Exploring the anatomy and physiology of ageing: Part 10 – muscles and bone, Nursing Times; 104: 48, 21-22.

This article explores the major changes that occur to muscle and bone as a result of normal ageing.

The skeletal muscles function primarily to facilitate conscious movement of the body. Additionally, contraction of the major muscle groups aids venous return of blood to the heart and generates substantial amounts of heat to help maintain body temperature.

The skeletal system provides support, protects vulnerable regions and allows physical movement via a system of levers and articular joints. The bones also function as storage areas for fat, act as mineral reservoirs and house the red bone marrow responsible for blood-cell production.

With age, the musculoskeletal components undergo progressive degeneration.

Age-related changes in muscle

Sarcopenia (atrophy and loss of mass)
Skeletal muscles atrophy and decrease in mass with age (Fig 1). This is known as sarcopenia and is reflected by a gradual decrease in body strength.

Maximal muscle mass and strength is usually achieved in the 20s and 30s and gradually declines into middle age. At around the age of 60, loss of muscle tissue accelerates, often leading to progressive weakness (Spirduso, 1995). In late old age, loss of muscle tissue from the limbs may be so prominent that they appear stick-like and little more than skin and bone.

Similarly, atrophy of the intercostal muscles leads to the development of deep furrows between the ribs, while loss of facial muscle tissue deprives the skin of underlying support and contributes to the loosening and sagging of the features.

The prominent loss of muscle tissue usually seen in later years is commonly referred to as senile sarcopenia.

Loss of strength in older people appears to be directly attributable to physiological and histological changes within the skeletal muscles (Freemont and Hoyland, 2007). These changes are outlined below.

Anatomical and physiological changes in aged muscle tissue include:

  • Reduction in the number of muscle fibres;

  • Reduction in muscle fibre size;

  • Progressive replacement of active muscle fibres by collagen-rich non-contractile fibrous tissue;

  • Increased deposition of fat at the expense of lean muscle tissue;

  • Accumulation of lipofuscin (an age-related pigment);

  • Mitochondria within muscle fibres becoming less efficient at releasing energy during metabolism;

  • Reduction in blood flow to the major muscle groups;

  • Reduction in motor neuron numbers.

It is thought that sarcopenia is primarily attributable to loss of motor neuron fibres (denervation). This leads to reduced stimulation of muscle groups and therefore loss of motor units (muscle mass).

Sarcopenia is aggravated in older people because of the reduced levels of circulating anabolic hormones, such as somatotropin and testosterone, which are usually in decline from middle age onwards (see articles on ageing of the endocrine and reproductive systems).

As skeletal muscles are metabolically very active, sarcopenia is a major factor contributing to the age-related reduction in the metabolic rate. If calorific intake remains at the same level as in younger years, there is a much greater chance that the excess calories not utilised by lean muscle will be stored in the form of fat.

Skeletal muscles play a major role in supporting the body. Loss of muscle mass leads to a progressive reduction in the level of support afforded to the skeleton and contributes to the gradual changes in posture observed with age (Fig 2). The weakness that accompanies sarcopenia increases the chances of falls and fractures.

Age-related changes in bone
Maximal bone mass and density is usually attained between the ages of 25 and 30 and gradually decreases thereafter (Montague et al, 2005). The decalcification of bone accelerates in middle age, particularly in women who are postmenopausal.

Many factors are known to contribute to bone loss, including:

  • Reduction in the levels of oestrogen in women and testosterone in men;

  • Reduction in the levels of somatotropin (growth hormone);

  • Reduction in calcium and vitamin D absorption;

  • Slight increases in the levels of parathyroid hormone.

Loss of bone mass is exacerbated by the reduced activity levels often seen in older people. Bone-forming cells (osteoblasts) will only continue to deposit calcium efficiently when bones are put under the stress of weight-bearing exercise. However, the bone-digesting cells (osteoclasts) break down bone continually at a fairly uniform rate and therefore, in sedentary people, it
is common for bone decalcification to become rapid.

Age-related loss of skeletal muscle mass also results in less load (both weight and contractile force) being exerted on
the bones, which further contributes to bone decalcification.

The loss of calcium from the aged skeleton commonly leads to the bones taking on the porous sponge-like appearance indicative of osteoporosis. The vertebrae of the spine are particularly vulnerable and may become compressed and deformed, leading to the characteristic stooping curvature of the spine often seen in old age (Fig 2).

Decalcification may lead to bone-thinning, particularly in the flat bones. This is often apparent in the scapulae (shoulder blades) which, on examination, may have a threadbare ‘moth-eaten’ appearance. Demineralisation may be so profound that holes appear in these once solid sheets of bone.

Decreases in bone density are associated with an increased risk of fracture. Older women commonly show prominent loss of bone from the femoral neck, which may fracture when it becomes too thin to be able to support the weight of the body.

Joint changes
The cartilages within articular (synovial) joints play an important role as shock absorbers, as well as ensuring the correct spacing and separation of bones.

The activity of the cartilage-forming cells (chondrocytes) decreases with age (Freemont and Hoyland, 2007), leading to a reduction in the amounts of cartilage present in many joints. This can lead to aged joints becoming more susceptible to mechanical damage and increase the chances of painful bone-to-bone contact.

Ageing is the biggest risk factor for osteoarthritis. Indeed, the condition is apparent in the joint X-rays of virtually all older people, even in those displaying no symptoms of it (Montague et al, 2005).

The outer portion of a joint capsule is composed of elastic ligaments, which bind the joint together, preventing dislocation while allowing free movement. With age, the elasticity of the collagen and elastin components of ligaments reduce (Freemont and Hoyland, 2007), resulting in reduced joint mobility. Certain joints are particularly susceptible; for example, in women the ankle joint loses up to 50% of its flexibility and range of motion between the ages of 55 and 85 (Vandervoort et al, 1992).

Although the majority of age-related changes described in this article appear to be inevitable, many can be delayed by undertaking light exercise. Weight-bearing exercise increases bone density, improves joint function and stimulates skeletal muscle growth (Spirduso, 1995). Increasing the intake of calcium, vitamin D and lean protein can increase bone density and provide amino acids for muscle growth. This may offset the reduction in efficiency of nutrient absorption often seen in older age.

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References

Freemont, A.J., Hoyland, J.A. (2007) Morphology, mechanisms and pathology of musculoskeletal ageing. The Journal of Pathology; 211: 2, 252-259.

Montague, S.E. et al (2005) Physiology for Nursing Practice (3rd ed). Oxford: Baillière Tindall.

Spirduso, W.W. (1995) Physical Dimensions of Aging. Champaign, IL: Human Kinetics.

Vandervoort, A.A. et al (1992) Age and sex effects on the mobility of the human ankle. Journal of Gerontology: Medical Sciences; 47: 17-21.

 

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Boomers Should Add Muscle Before It’s Too Late

 

WEDNESDAY, Sept. 24 (HealthDay News) — Strength training can help people build muscle mass to assist in the fight against the debilitating effects of old age until they reach 80, a new study says.

After that, not so much, according to the authors.

The Ball State University study, sponsored by a grant from the U.S. National Institutes of Health, found that while six men in their 80s did get somewhat stronger, their whole muscle size and fiber size did not grow during a 12-week training regime.

“We know that there is accelerated muscle loss as we get older,” Scott Trappe, director of Ball State’s Human Performance Laboratory, said in a university news release. “The best way to keep our muscles from shrinking is through resistance training, which allows our body to maintain muscle size and strength as we go through our 60s and 70s.”

Trappe said aging eventually causes the loss of “fast-twitch” muscle fibers, reducing the ability to produce the explosive movements that allow us to move our feet and arms to keep from falling. The concurrent loss of slow-twitch muscles, the large ones found in the legs, thighs, trunk, back and hips, weakens posture as well. Together, these losses make it harder to balance and maintain an independent life.

“At this point,” he said, “I would advise people to actively engage in some sort of resistance training once they hit their 60s. From our study, once you hit the threshold of 80, that may not be possible.”

A 2003 study published in theJournal of the American Geriatrics Society, estimated U.S. health care costs directly attributed to sarcopenia, the degenerative loss of skeletal muscle mass and strength, exceeds $26 billion. Indirectly, sarcopenia has contributed to a doubling of home health care and nursing home expenditures to $132 billion annually.

More information

The U.S. Centers for Disease Control and Prevention has more about healthy living for older adults.

SOURCE: Ball State University, news release, Sept. 11, 2008

 

Pulling back a curtain on age and weakness | Los Angeles Times

“I think the problem is that people just accept muscle loss as part of old age,” said Christy Carter, an assistant professor at the University of Florida Department of Aging and Geriatrics, who is doing research on sarcopenia in rats. “But it is a huge and growing health concern.”

“There is no sarcopenia association. We don’t have pills for it and we don’t pay doctors to treat it,” said [Bernard A. Roos], who has done numerous studies on sarcopenia.

Roos thinks that is changing. “When I started looking at osteoporosis in 1972, people told me there never would be a cure. Now we have 20 drugs that treat it,” he said. “Before I retire, we will have sarcopenia treatments.”

Reproduced with permission of the copyright owner. Further reproduction or distribution is prohibited without permission.

 

Keep It Movin’ | Good Form

By Sara Baker | Thursday, April 5, 2007, 06:00 AM

The Atlanta Journal-Constitution

I say this all the time to clients, “move it or lose it.” But it really is true. Just about every system in our body will atrophy, decline, wither, weaken, or become inefficient if it is not regularly challenged and/or utilized.

The definition of this decline in the skeletal muscle system (the type of muscles that move your body) is called sarcopenia. Sarcopenia is a greek word meaning “poverty of flesh.” Sarcopenia is a universal part of the aging process. The process of gradual muscle loss starts in your thirties and becomes significant in your fifties. At age 80 more than 50% of people will have clinically determined sarcopenia that is defined as 2 standard deviations below the mean of the average healthy population.

The impact on this loss of muscle mass is enormous. It decreases your ability to recovery from injury, illness, or disease because muscle mass stores nitrogen and amino acids that are essential for our autoimmune system to function. And it decreases your ability to function by decreasing your strength, balance and endurance. Sarcopenia costs our country $18.1 BILLION dollars each year in healthcare expenditures.

The really wonderful thing is that sarcopenia is preventable through regular resistance/strength training. Just as regular cardiovascular exercise is important to keep our heart and lungs in good shape and prevent disease as we age, resistance exercise helps to keep our muscular system from wasting and strength from declining. And don’t think you can’t build muscle/strength if you are over a certain age. Studies have shown that men and women in their nineties can build muscle mass and strength with resistance exercise.

Does anyone have creative ways they make sure they incorporate strength training into their workouts?