Wiener Medizinische Wochenschrift

, Volume 161, Issue 17–18, pp 416–425 | Cite as

Physical activity, exercise, and sarcopenia – future challenges

Main topic

Summary

BACKGROUND: Numerous studies have demonstrated that the etiology of sarcopenia is multi-causal and very complex process. The degradation of muscle mass leads to a loss of strength, later on to a decreased functional status, impaired mobility, a higher risk of falls, and eventually an increased risk of mortality. Present guidelines state that physical inactivity or a decreased physical activity level is a part of the underlying mechanisms of sarcopenia and therefore physical activity can be seen as an important factor to reverse or modify the development of sarcopenia. TOPIC: Results in the area of physical activity and aging have not always been homogeneous. The inconsistent findings in this research area are related to the different understanding of terms and underlying constructs along with different population, type of intervention, or measurement methods. These aspects will be discussed in the paper. With regard to the formulated future role of physical activity this article will discuss in addition different barriers and challenges in the prevention and treatment of sarcopenia. A multitude of studies shows that structured exercise programs including progressive resistance or power training have positive effects on sarcopenia and sarcopenia-related outcomes but less or inconclusive information is available for the transfer to functional outcomes. CONCLUSIONS: Both physical activities and exercise have shown to decrease risk of sarcopenia and onset of functional limitations in older persons. Unfortunately the cohort of older persons is the one with the highest percentage of individuals classified as inactive or sedentary. Therefore motivating older persons to increase their physical activity level as well as providing safe access to exercise programs seems to be a mandatory task.

Keywords

Older persons Physical activity Exercise Sarcopenia Definitions of terms 

Körperliche Aktivität, Training und Sarkopenie – zukünftige Herausforderungen

Zusammenfassung

GRUNDLAGEN: Viele Studien haben nachgewiesen, dass die Ethologie von Sarkopenie multikausal und sehr komplex ist. Die Verminderung der Muskelmasse führt zu einem Verlust von Muskelkraft, später zu einem abnehmenden funktionellem Status mit eingeschränkter Mobilität, damit wiederum zu einem höheren Sturzrisiko und zum Schluss zu einem höheren Mortalitätsrisiko. Aktuelle Empfehlungen und Leitlinien geben an, dass körperliche Inaktivität oder ein abnehmendes Niveau der körperlichen Aktivität Teil des Entstehungszyklus von Sarkopenie sind und deshalb körperliche Aktivität als wichtige Säule bei der Entwicklung und Behandlung von Sarkopenie berücksichtigt werden muss. THEMA: Ergebnisse zum Zusammenhang von körperlicher Aktivität und dem Alternsprozess haben nicht immer eindeutige Resultate gezeigt. Diese Inkonsistenz der wissenschaftlichen Ergebnisse ist zum Einen darauf zurückzuführen, dass Begriffe und das zugrunde liegende Konstrukt nicht einheitlich benutzt werden. Zum Anderen beruhen die unterschiedlichen Ergebnisse in der Heterogenität der Zielpopulation, Art der Interventionen oder auch den eingesetzten Messinstrumentarien. Diese Aspekte werden in dem Artikel thematisiert. Mit Bezug auf die zukünftigen Herausforderungen für die Rolle und den Einsatz von körperlicher Aktivität werden zusätzlich in diesem Artikel mögliche Barrieren und Anregungen zur Prävention und Behandlung von Sarkopenie diskutiert. Eine Vielzahl von Studien zeigt, dass strukturierte und gut geplante Trainingsprogramme, bestehend aus progressivem Krafttraining oder einem Schnellkrafttraining, positive Effekte auf die Sarkopenie oder Sarkopenie bezogene Komponente haben. Weniger eindeutig ist allerdings der Erkenntnisstand zum Transfer dieser Ergebnisse auf funktionelle Parameter. SCHLUSSFOLGERUNGEN: Beides, körperliche Aktivität und Training, haben gezeigt, dass sie das Sarkopenierisiko und den Beginn von funktionellen Einschränkungen bei älteren Menschen reduzieren können. Unglücklicherweise weist die Kohorte älterer Menschen gerade die höchsten Anteile von inaktiven oder gering aktiven Menschen auf. Deshalb scheint es zwingend notwendig, ältere Menschen zu motivieren, ihr körperliches Aktivitätsniveau zu erhöhen und sicheren Zugang sowie entsprechenden Trainingsprogramme bereit zu stellen.

Schlüsselwörter

Ältere Menschen Körperliche Aktivität Training Sarkopenie Begriffsdefinitionen 

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References

  1. Vita A, Terry RB, Hubert HB, Fries JF. Aging, health risks, and cumulative disability. New Engl J Med, 338: 1035–1041, 1998CrossRefPubMedGoogle Scholar
  2. Rikli E, Jones CJ. Assessing physical performance in independent older adults: issues and guidelines. JAPA, 5: 244–261, 1997CrossRefGoogle Scholar
  3. Fries JF, Green LW, Levine S. Health promotion and the compression of morbidity. Lancet, 1: 481–483, 1989CrossRefPubMedGoogle Scholar
  4. Evans W, Rosenberg, IR. Biomarkers: the ten determinants of aging you can control. Simon & Schuster, New York, 1991Google Scholar
  5. Evans W, Campbell WW. Sarcopenia and age-related changes in body composition and functional capacity. J Nutr, 123: 465–468, 1993PubMedGoogle Scholar
  6. Evans W. What is sarcopenia? J Gerontol A Biol Sci Med Sci, 50(Spec No:5–8): 1995Google Scholar
  7. Evans W. Skeletal muscle loss: cachexia, sarcopenia, and inactivity. Am J Clin Nutr, 91: 1123S–1127S, 2010CrossRefPubMedGoogle Scholar
  8. Verdijk L, Gleeson B, Jonkers R, et al. Skeletal muscle hypertrophy following resistance training is accompanied by a fiber type-specific increase in satellite cell content in elderly men. J Gerontol A Biol Sci Med Sci, 64: 332–339, 2009CrossRefPubMedGoogle Scholar
  9. Delmonico MJ, Harris TB, Lee J-S, et al. Alternative definitions of sarcopenia, lower extremity performance, and functional impairment with aging in older men and women. J Am Geriatr Soc, 55: 769–774, 2007CrossRefPubMedGoogle Scholar
  10. Patel H, Syddall H, Martin H, et al. Hertfordshire sarcopenia study: design and methods. BMC Geriatr, 10: 43, 2010CrossRefPubMedPubMedCentralGoogle Scholar
  11. Sayer A. Sarcopenia. BMJ, 341: c4097, 2010CrossRefPubMedGoogle Scholar
  12. Sayer A, Syddall H, Martin H, et al. Falls, sarcopenia, and growth in early life: findings from the Hertfordshire cohort study. Am J Epidemiol, 164: 665–671, 2006CrossRefPubMedPubMedCentralGoogle Scholar
  13. Muhlberg W, Sieber, C. Sarcopenia and frailty in geriatric patients: implications for training and prevention. Z Gerontol Geriatr, 37: 2–8, 2004CrossRefPubMedGoogle Scholar
  14. Roubenoff R. Sarcopenia: effects on body composition and function. J Gerontol A Biol Sci Med Sci, 58: 1012–1017, 2003CrossRefPubMedGoogle Scholar
  15. Janssen I, Heymsfield S, Ross R. Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc, 50: 889–896, 2002CrossRefPubMedGoogle Scholar
  16. Janssen I, Shepard D, Katzmarzyk P, et al. The healthcare costs of sarcopenia in the United States. J Am Geriatr Soc, 52: 80–85, 2004CrossRefPubMedGoogle Scholar
  17. Cruz-Jentoft A, Baeyens, JP, Bauer JM, et al. European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing, 39: 412–423, 2010CrossRefPubMedPubMedCentralGoogle Scholar
  18. Landi F, Abbatecola A, Provinciali M, et al. Moving against frailty: does physical activity matter? Biogerontology, 11: 537–545, 2010CrossRefPubMedGoogle Scholar
  19. Chodzko-Zajko W, Proctor DN, Fiatarone Singh MA, et al. American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc, 41: 1510–1530, 2009CrossRefPubMedGoogle Scholar
  20. Buchner D. Physical activity and prevention of cardiovascular disease in older adults. Clin Geriatr Med, 25: 661–675, viii, 2009CrossRefPubMedGoogle Scholar
  21. US Department of Health & Human Services [USDHHS]. Physical guidelines for American. 2010. Available at: http://www.healthypeople.gov/default.htm. Accessed August 28th 2010
  22. Paterson D, Jones GR, Rice CL. Ageing and physical activity: evidence to develop exercise recommendations for older adults. Can J Public Health, 98: S69–S108, 2007PubMedGoogle Scholar
  23. Bouchard C, Blair SN, Haskell WL. Physical activity and health. 2nd edn. Human Kinetics, Champaign, 2007Google Scholar
  24. Nelson ME, Rejeski WJ, Blair SN, et al. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Circulation, 116: 1094–1105, 2007CrossRefPubMedGoogle Scholar
  25. Keysor JJ. Does late-life physical activity or exercise prevent or minimize disablement? Am J Prev Med, 25: 129–136, 2003CrossRefPubMedGoogle Scholar
  26. Singh MA. Exercise comes of age: rationale and recommendations for a geriatric exercise prescription. J Gerontol A Biol Sci Med Sci, 57: M262–M282, 2002CrossRefPubMedGoogle Scholar
  27. Cesari M, Pahor M, Lauretani F, et al. Skeletal muscle and mortality results from the InCHIANTI Study. J Gerontol A Biol Sci Med Sci, 64: 377–384, 2009CrossRefPubMedGoogle Scholar
  28. Rolland Y, Lauwers-Cances V, Cournot M, et al. Sarcopenia, calf circumference, and physical function of elderly women: a cross-sectional study. J Am Geriatr Soc, 51: 1120–1124, 2003CrossRefPubMedGoogle Scholar
  29. Physical Activity Guidelines Advisory Committee Report [PAACR] (2008) Part C- Key Terms. Available at: http://www.health.gov/paguidelines/Report/Default.aspx. Access August 28th 2010
  30. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep, 100: 126–131, 1985PubMedPubMedCentralGoogle Scholar
  31. United States Public Health Service, Office of the Surgeon General, National Center for Chronic Disease Prevention and Health Promotion, President's Council on Physical Fitness and Sports (USPHS). Physical activity and health: a report of the Surgeon General. Atlanta, GA.: U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; President's Council on Physical Fitness and Sports; 1996Google Scholar
  32. American College of Sport Medicine. ACSM's Guidelines for Exercise Testing and Prescription. 6th edn. Williams & Wilkins, Philadelphia, 2006Google Scholar
  33. Brach J, Simonsick EM, Kritchevsky St, et al. The association between physical function and lifestyle activity and exercise in the health, aging and body composition study. J Am Geriatr Soc, 52: 502–509, 2004CrossRefPubMedGoogle Scholar
  34. Sallis R. Exercise is medicine and physicians need to prescribe it! Br J Sports Med, 43: 3–4, 2009CrossRefPubMedGoogle Scholar
  35. Bouchard CSRJ, Stephens T. Physical activity, fitness, and health: the model and key concepts. In: Bouchard C, Shephard RJ (eds). Physical activity, fitness, and health: international proceedings and consenus staement. Human Kinetics, Champaign, IL, pp. 77–88, 1994Google Scholar
  36. Pate R. The evolving definition of fitness. Quest, 40: 174–179, 1988CrossRefGoogle Scholar
  37. Cress M, Schechtman KB, Mulrow CD, et al. Relationship between physical performance and self-perceived physical function. J Am Geriatr Soc, 43: 93–101, 1995CrossRefPubMedGoogle Scholar
  38. Guralnik J, Simonsick E, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol, 49: M85–M94, 1994CrossRefPubMedGoogle Scholar
  39. Espeland M, Gill TM, Guralnik J, et al. Designing clinical trials of interventions for mobility disability: results from the lifestyle interventions and independence for elders pilot (LIFE-P) trial. J Gerontol A Biol Sci Med Sci, 62: 1237–1243, 2007CrossRefPubMedPubMedCentralGoogle Scholar
  40. Balzi D, Lauretani F, Barchielli A, et al. Risk factors for disability in older persons over 3-year follow-up. Age Ageing, 39: 92–98, 2010CrossRefPubMedGoogle Scholar
  41. Manini T, Pahor M. Physical activity and maintaining physical function in older adults. Br J Sports Med, 43: 28–31, 2009CrossRefPubMedGoogle Scholar
  42. Peterson M, Giuliani C, Morey M, et al. Physical activity as a preventative factor for frailty: the health, aging, and body composition study. J Gerontol A Biol Sci Med Sci, 64: 61–68, 2009CrossRefPubMedGoogle Scholar
  43. Brown D, Brown DR, Heath GW, et al. Association between physical activity dose and health-related quality of life. Med & Scien Sports & Exercise, 36: 890–896, 2004CrossRefGoogle Scholar
  44. Puthoff M, Janz K, Nielson D. The relationship between lower extremity strength and power to everday walking behaviors in older adults with functional limitations. J Geriatr Phys Ther, 31: 24–31, 2008CrossRefPubMedGoogle Scholar
  45. Peterson M, Rhea MR, Sen A, et al. Resistance exercise for muscular strength in older adults: a meta-analysis. Ageing Res Rev, 9: 226–237, 2010CrossRefPubMedPubMedCentralGoogle Scholar
  46. Liu CJ, Latham NK. Progressive resistance strength training for improving physical function in older adults. Cochrane Database Syst Rev, 2009; Issue 3. Art. No.: CD002759. Doi: 10.1002/14651858.CD002759.pub2
  47. Martin H, Syddall HE, Dennison EM, et al. Relationship between customary physical activity, muscle strength and physical performance in older men and women: findings from the Hertfordshire Cohort Study. Age Ageing, 37: 589–593, 2008CrossRefPubMedGoogle Scholar
  48. Spirduso W, Francis KL, MacRae PG. Physical dimensions of aging, 2nd edn. Human Kinetics, Champaign, 2005Google Scholar
  49. Buchner D, Beresford SAA, Larson EB, et al. Effects of physical activity on health status in older adults II: intervention studies. Ann Rev Publ Health, 13: 469–488, 1992CrossRefGoogle Scholar
  50. Rantanen T, Guralnik JM, Sakari-Rantala R. Disability, physical activity, and muscle strength in older women: the women's health and aging study. Arch Phys Med Rehabil, 80: 130–135, 1999CrossRefPubMedGoogle Scholar
  51. Chalé-Rush A, Guralnik J, Walkup M, et al. Relationship between physical functioning and physical activity in the lifestyle interventions and independence for elders pilot. J Am Geriatr Soc, 58: 1918–1924, 2010CrossRefPubMedPubMedCentralGoogle Scholar
  52. Steib S, Schoene D, Pfeifer K. Dose-response relationship of resistance training in older adults: a meta-analysis. Med Sci Sports Exerc, 42: 902–914, 2010CrossRefPubMedGoogle Scholar
  53. Bean JF, Kiely DK, LaRose S, et al. Increased velocity exercise specific to task training versus the National Institute on Aging's strength training program: changes in limb power and mobility. J Gerontol A Biol Sci Med Sci, 64: 983–991, 2009CrossRefPubMedGoogle Scholar
  54. Protas E, Tissier, S. Strength and speed training for elders with mobility disability. J Aging Phys Act, 17: 257–271, 2009CrossRefPubMedPubMedCentralGoogle Scholar
  55. Reid K, Callahan DM, Carabello RJ, et al. Lower extremity power training in elderly subjects with mobility limitations: a randomized controlled trial. Aging Clin Exp Res, 20: 337–343, 2008CrossRefPubMedPubMedCentralGoogle Scholar
  56. Fiatarone M, Marks EC, Ryan ND, et al. High-intensity strength training in nonagenarians. Effects on skeletal muscle. JAMA, 263: 3029–3034, 1990CrossRefPubMedGoogle Scholar
  57. Cuoco A, Callaham DM, Sayers ST, et al. Impact of muscle power and force on gait speed in disabled older men and women. J Gerontol A Biol Sci Med Sci, 59: 1200–1206, 2004CrossRefPubMedGoogle Scholar
  58. Bean JF, Leveille SG, Kiely DK, et al. A comparison of leg power and leg strength within the InCHIANTI study: which influences mobility more? J Gerontol A Biol Sci Med Sci, 58: M728–M733, 2003CrossRefGoogle Scholar
  59. Henwood T, Taaffe DR. Short-term resistance training and the older adult: the effect of varied programmes for the enhancement of muscle strength and functional performance. Clin Physiol Funct Imaging, 26: 305–313, 2006CrossRefPubMedGoogle Scholar
  60. Frontera W, Hughes VA, Fielding RA, et al. Aging of skeletal muscle: a 12-yr longitudinal study. J Appl Physiol, 88: 1321–1326, 2000PubMedGoogle Scholar
  61. Skelton DA, Greig CA, Davies JM, et al. Strength, power and related functional ability of healthy people aged 65–89 years. Age Ageing, 23: 371–377, 1994CrossRefPubMedGoogle Scholar
  62. Bean J, Herman S, Kiely DK, et al. Increased velocity exercise specific to task (InVEST) training: a pilot study exploring effects on leg power, balance, and mobility in community-dwelling older women. J Am Geriatr Soc, 52: 799–804, 2004CrossRefPubMedGoogle Scholar
  63. Manini T, Marko M, VanArnam T, et al. Efficacy of resistance and task-specific exercise in older adults who modify tasks of everyday life. J Gerontol A Biol Sci Med Sci, 62: 616–623, 2007CrossRefPubMedGoogle Scholar
  64. de Vreede PL, Samson MM, van Meeteren NLU, et al. Functional-task exercise versus resistance strength exercise to improve daily function in older women: a randomized, controlled trial. J Am Geriatr Soc, 53: 2–10, 2005CrossRefPubMedGoogle Scholar
  65. Skelton DA, Young A, Greig CA, et al. Effects of resistance training on strength, power, and selected functional abilities of women aged 75 and older. J Am Geriatr Soc, 43: 1081–1087, 1995CrossRefPubMedGoogle Scholar
  66. Faber M, Bosscher RJ, Chin A, Paw MJ, van Wieringen PC. Effects of exercise programs on falls and mobility in frail and pre-frail older adults: a multicenter randomized controlled trial. Arch Phys Med Rehabil, 87: 885–896, 2006CrossRefPubMedGoogle Scholar
  67. Luukinen H, Lehtola S, Jokelainen J, et al. Prevention of disability by exercise among the elderly: a population-based, randomized, controlled trial. Scand J Prim Health Care, 24: 199–205, 2006CrossRefPubMedGoogle Scholar
  68. Gill TM, Baker DI, Gottschalk M, et al. A program to prevent functional decline in physically frail, elderly persons who live at home. N Engl J Med, 347: 1068–1074, 2002CrossRefPubMedGoogle Scholar
  69. Chandler J, Duncan PW, Kochersberger G, et al. Is lower extremity strength gain associated with improvement in physical performance and disability in frail, community-dwelling elders? Arch Phys Med Rehabil, 79: 24–30, 1998CrossRefPubMedGoogle Scholar
  70. Centers for Disease Control and prevention 2007. US Physical activity statistics. Available at: http://apps.nccd.cdc.gov/PASurveillance/StateSumResultV.asp?CI=&Year=2007&State=0#data. Accessed 4. September 2010
  71. Ferrucci LS, Simonsick EM. A little exercise. J Gerontol A Biol Sci Med Sci, 61: 1154–1156, 2006CrossRefPubMedPubMedCentralGoogle Scholar
  72. US Department of Health & Human Services [USDHHS]. Healthy people 2010. Available at: www.health.gov/paguidelines. Accessed August 28th 2010
  73. Scholz U, Sniehotta F, Burkert S, et al. Increasing physical exercise levels: age-specific benefits of planning. J Aging Health, 19: 851–866, 2007CrossRefPubMedGoogle Scholar
  74. Jerome G, Glass T, Mielke M, et al. Physical activity participation by presence and type of functional deficits in older women: the women's health and aging studies. J Gerontol A Biol Sci Med Sci, 61: 1171–1176, 2006CrossRefPubMedGoogle Scholar
  75. Belza B, Walwick J, Shiu-Thornton S, et al. Older adult perspectives on physical activity and exercise: voices from multiple cultures. Prev Chronic Dis, 1: A09, 2004PubMedPubMedCentralGoogle Scholar
  76. McAuley E, Blissmer B. Self-efficacy determinants and consequences of physical activity. Exerc Sport Sci Rev, 28: 85–88, 2000PubMedGoogle Scholar
  77. Jonas S, Philipps EM. ACSM's exercise is medicine. Lippincott, Williams & Wilkins, Philadelphia, 2009Google Scholar
  78. Ganz K, Rimer BK, Lewis FM. Health behavior and health education 3rd. Jossey-Bass, San-Francisco, 2002Google Scholar
  79. Lee L, Arthur A, Avis M. Using self-efficacy theory to develop interventions that help older people overcome psychological barriers to physical activity: a discussion paper. Int J Nurs Stud, 45: 1690–1699, 2008CrossRefPubMedGoogle Scholar
  80. Resnick B, Spellbring A. Understanding what motivates older adults to exercise. J Gerontol Nurs, 26: 34–42, 2000CrossRefPubMedGoogle Scholar
  81. Fishbein M, Aijzen I. Beliefs, Attitude, Intention, and Behavior: An Introduction to theory and Research. Addison-Wesley, Reading Mass, 1975Google Scholar
  82. Freiberger E, Menz HB, Abu-Omar K, et al. Preventing falls in physically active community-dwelling older people: a comparison of two intervention techniques. Gerontology, 53(5): 298–305, 2007CrossRefPubMedGoogle Scholar
  83. McAuley E, Hall KS, Motl RW, et al. Trajectory of declines in physical activity in community-dwelling older women: social cognitive influences. J Gerontol B Psychol Sci Soc Sci, 64: 543–550, 2009CrossRefPubMedGoogle Scholar
  84. Rejeski W, Miller M, King A, et al. Predictors of adherence to physical activity in the lifestyle interventions and independence for elders pilot study (LIFE-P). Clin Interv Aging, 2: 485–494, 2007PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Ellen Freiberger
    • 1
  • Cornel Sieber
    • 2
  • Klaus Pfeifer
    • 1
  1. 1.Institute of Sport Science and SportsFriedrich-Alexander-University Erlangen-NürnbergErlangenGermany
  2. 2.Institute for Biomedicine of AgingUniversity of Erlangen-NürnbergErlangenGermany

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