Strength Improvements Over Age 90

For patients over the age of 80, research estimates the prevalence at greater than 50%.2 Of course, it is well established that geriatric patients can gain strength and ability through professionally designed programs. On the other hand, prescribers also know that patients over the age of 80 lose significant myocellular plasticity, which considerably blunts the muscle hypertrophic response.3,4 This can discourage referrals for strengthening programs for issues such as fall prevention, back pain, shoulder pain, progressive geriatric disability, etc., especially for patients among the oldest old.

Fortunately, a collection of studies show the various ways that resistance training, even at low levels, safely elicits improvements in muscular strength in the very old (>85 years).5-10 Noteworthy among these studies is the work led by Jose´ A. Serra-Rexach, MD, PhD, Geriatric Department, Hospital General Universitario Gregorio Maran˜o´n, Madrid, Spain. His randomised, controlled trial, published in the Journal of the American Geriatrics Society, only includes very elderly subjects, age 90 to 97.

Additionally, where other studies use high-intensity training, this particular study experiments with only light-to-moderate intensity exercises. The control group of 20 nonagenarians was instructed in gentle stretching and range of motion exercises to be performed five times per week. The experimental group was scheduled for 24 professionally-supervised exercise sessions over eight weeks. These 45-minute sessions included aerobics and strength training - all at 30-70% of maximum exertion. The experimental group achieved 75% adherence with each patient attending 18 sessions on average. Even light-to-moderate strength training for only eighteen sessions achieved a mean leg-press increase of 10.5 kg.

The strength training group experienced significantly fewer falls and trended better in walking speed, stair-climbing speed, and the timed-up-and-go test. Only one participant had a study-related adverse event. This participant experienced transient lumbalgia at the start of the training program. For this participant, researchers restarted the program with a lower load (40% exertion), which allowed him to finish the program successfully.

For prescribers, the takeaway message is that age alone should not discourage prescribers from recommending rehabilitation programs. In addition, the nonagenarians in this study were able to achieve these results despite the normal array of comorbidities associated with advanced age: 65% had hypertension; 60% had osteoarthritis; 60% had heart disease; and 35% had dementia. P

Professionally developed and supervised sarcopenia remediation programs can be tailored to the safety, goals, and progress of each patient. Such programs can also include activities consultation, to encourage long-term maintenance of the gains achieved.

References

1. Landi F, Liperoti R, Russo A, Giovannini S, Tosato M, Capoluongo E, Bernabei R, Onder G. Sarcopenia as a risk factor for falls in elderly individuals: results from the ilSIRENTE study. Clinical Nutrition. 2012 Oct 1;31(5):652-8.

2. Baumgartner RN, Koehler KM, Gallagher D, Romero L, Heymsfield SB, Ross RR, Garry PJ, Lindeman RD. Epidemiology of sarcopenia among the elderly in New Mexico. American Journal of Epidemiology. 1998 Apr 15;147(8):755-63.

3. Slivka D, Faue U, Hollon C, et al. Single muscle fiber adaptations to resistance training in old (>80 year) men: Evidence for limited skeletal muscle plasticity. Am J Physio Regul Integr Comp Physiol. 2008; 295: R273-R280.

4. Raue U, Slivka D, Minchev K, et al. Improvements in whole muscle and myocellular function are limited with high-intensity resistance training in octogenarian women. J Appl Physiol. 2009; 106: 1611-1617.

5. Fiatarone MA, Marks EC, Ryan ND, Meredith CN, Lipsitz LA, Evans WJ. High-intensity strength training in nonagenarians: effects on skeletal muscle. JAMA. 1990 Jun 13;263(22):3029-34.

6. Fiatarone MA, Marks EC, Ryan ND, Meredith CN, Lipsitz LA, Evans WJ. High-intensity strength training in nonagenarians: effects on skeletal muscle. JAMA. 1990 Jun 13;263(22):3029-34.

7. Krops LA, Hols DH, Folkertsma N, Dijkstra PU, Geertzen JH, Dekker R. Requirements on a communitybased intervention for stimulating physical activity in physically disabled people: a focus group study amongst experts. Disability and Rehabilitation. 2018 Sep 25;40(20):2400-7.

8. Serra‐Rexach JA, Bustamante‐Ara N, Hierro Villaran M, Gonzalez Gil P, Sanz Ibanez MJ, Blanco Sanz N, Ortega Santamaria V, Gutierrez Sanz N, Marin Prada AB, Gallardo C, Rodriguez Romo G. Short‐term, light‐to moderate‐intensity exercise training improves leg muscle strength in the oldest old: a randomized controlled trial. Journal of the American Geriatrics Society. 2011 Apr;59(4):594-602.

9. Fragala MS, Cadore EL, Dorgo S, Izquierdo M, Kraemer WJ, Peterson MD, Ryan ED. Resistance training for older adults: position statement from the national strength and conditioning association. The Journal of Strength & Conditioning Research. 2019 Aug 1;33(8).

10. Maria Martone A, Lattanzio F, Marie Abbatecola A, La Carpia D, Tosato M, Marzetti E, Calvani R, Onder G, Landi F. Treating sarcopenia in older and oldest old. Current Pharmaceutical Design. 2015 Apr 1;21 (13):1715-22.