Thursday, March 30, 2023

Muscles weaken as people age, but strength training can combat that


Like many in her age group, 97-year-old Sylvia McGregor from Sydney deals with her share of ailments – in her case, arthritis, osteoporosis, hearing loss, macular degeneration, lung disease, hypothyroidism, chronic kidney disease, heart disease and two total knee replacements. But ANDlike most nonagenarians, she does intense strength training twice a week.

She credits the exercises, which she has been doing for 12 years, with allowing her to live independently. “I still live alone and take care of myself,” she says. “It was only when I was in the hospital [in 2021] that they said I had to have a walker to get home alone. So I said, “That’s fine by me.”

McGregor is in one of the fastest growing age groups – individuals aged 80 and over. By 2050, this “older” group. expected to triple in number to 447 million worldwide.

Their life expectancy reflects improved management of chronic health conditions that allows older people to live longer even if they have serious health problems. But physical function deteriorates as people age, and many seniors become unable to care for themselves—eroding the quality of those extra years and decades.

Exercise is the best recipe for preserving independence, researchers say. But what is the right dose – in terms of frequency, intensity and duration? What type of exercise is best? At what age should you start – and how late is too late?

There are too few studies of exercise among older adults to provide definitive guidance for that age group, says Erin Howden, a researcher and exercise physiologist at the Baker Heart and Diabetes Institute and co-author of a summary of exercise in eight-year-olds in Annual Review of Medicine 2022. But the evidence for the “oldest young” – people aged 60 to 75 – is sufficient to provide good, basic advice for anyone who wants to continue working in their garden at 97.

Do you want to live to be 100 years old? Here’s what the experts recommend.

Independent living requires the ability to perform activities of daily living – bathing or showering, dressing, getting in and out of bed or a chair, walking, using the toilet, and eating.

Doing these things requires four physical attributes: cardiorespiratory fitness (how well the cardiovascular system and respiratory system supply oxygen during physical exertion); muscle strength and power; flexibility; and dynamic balance, meaning the ability to remain stable during movement.

Biological aging negatively affects each of them.

Cardiovascular fitness—the ability of the heart and blood vessels to deliver and use oxygen during exercise—declines during adulthood as our circulatory capacity declines. This decline accelerates very late in life. Over 70, cardiovascular fitness declines by more than 21 percent per decade—and that’s for healthy people. Prolonged inactivity and common chronic conditions such as heart failure, diabetes and obesity make the situation worse. It is common for octogenarians to have such low cardiovascular function that it plays a role in preventing them from performing basic activities like vacuuming and cooking.

Dynamic balance, necessary for walking, climbing stairs and avoiding falls, also declines, thanks to the deterioration of the musculoskeletal system and neurological function. AND Muscle mass decreases by about 3 to 8 percent per decade after the age of 30, with the decline accelerating after the 60s. This often reduces both muscle strength—the ability of muscles to exert force, allowing us to lift objects—and muscle power, the ability to do the work quickly that we need to climb stairs. The more immobile you are, the faster this loss can proceed.

This loss of muscle, known as sarcopenia, is why walking, one of the most popular forms of exercise, may not be enough to keep us functioning independently.

“People think, ‘Oh, I walk,’ but walking isn’t going to help you build muscle,” public health scientist Rebecca A. Seguin-Fowler, associate director of Healthy Living at the Texas A&M AgriLife Institute, tells advancing health through agriculture.

Of the federal government Exercise guidelines for adults recommend at least 150 minutes per week of moderate-intensity aerobic activity (or 75 minutes of vigorous activity), along with muscle-strengthening exercises such as lifting weights or working with resistance bands—at least eight to 12 repetitions of each exercise – at least two days a week. For this, persons 65 years of age or older should add balance and flexibility training—think tai chi, pilates, or yoga—about three days a week.

There are many ways to tick the aerobic exercise box. A analysis of 41 clinical trials involving older people with an average age of 67 found that many regimens work, including walking, running, dancing and other activities, at varying intensity levels and durations. In general, the more often a person exercises, the greater the benefit.

Aerobic training earlier in life is better at preventing — and at younger ages, even reversing — the normal age-related hardening of the arteries that is a risk factor for hypertension and stroke. For example, a small Study of 10 healthy but sedentary people aged 65 and over who over the course of a year worked up to 200 minutes a week of vigorous aerobic exercise improved their cardiovascular fitness, but the training had no effect on their arterial stiffness. In contrast, a small study of adults aged 49 to 55 found that cardiovascular fitness improved and cardiac stiffness decreased through a combination of high-, moderate-, and low-intensity aerobic exercise for 150 to 180 minutes per week for two years.

Howden, who led the second study, sees a clear solution: “Middle and late middle age is when we need to get serious about incorporating a structured exercise program into our daily lives.”

And the muscles? Two decades of research have shown that resistance training can prevent and even reverse weight loss muscle massthe power and strength that people typically experience as they age. Here’s what works, according to an analysis of 25 studies involving people 60 and older, with an average age of 70: Exercisers should have two weight-training sessions per week, at an exercise intensity of 70 to 79 percent of their “maximum with a repetition”. ” — the maximum load they could fully lift if they did it just once. Each session includes two to three sets of each exercise and seven to nine repetitions per set.

Regarding fitness for older adults, the first study of this group was a clinical trial of 100 frail and elderly Boston nursing home residents. The average age was just over 87 years, and more than a third of the participants were 90 years or older. The vast majority – 83 percent – used a cane, walker or wheelchair; half had arthritis; many had lung disease, bone fractures, hypertension, cognitive impairment or depression.

Individuals assigned to the exercise group completed a regimen of high-intensity resistance training of the thigh and knee muscles three days per week for 10 weeks. For each of the muscle groups, the resistance machines were set at 80 percent of the one-repetition maximum. The training was progressive, meaning that the load was increased in each training session if the individual could tolerate it. The sessions lasted 45 minutes, and in each session, the exerciser performed three sets of eight lifts for each muscle group.

By the end of the trial, the exercisers had significantly increased muscle strength and mobility in their hips and knees compared to a non-exercise group. Four participants no longer used walkers after training, walking with a cane.

The principal investigator for that study was Maria A. Fiatarone Singh, now a geriatrician at the University of Sydney. For older people, she says, strength training, which helps with balance, is the priority exercise because it makes other forms of activity possible.

“Most people, including health care professionals, still have this idea that the most important thing is to help people walk around, but that’s only important if they can walk,” she says. “You have to have strength and balance first.”

Fiatarone Singh started the strength training program in which McGregor and her older peers press weights twice a week, and no one is getting off easy. “We actually increase the weight whenever we see someone when they’re first starting out,” says Singh. “At some point, their gains are less steep, but they still gain muscle mass if you keep increasing the weight.”

When she looks at a graph of McGregor’s muscle mass over time — “Hers is strong” — Fiatarone Singh sees inspiration.

“When someone in their 90s sees themselves getting stronger,” she says, “they’ll tell you how good it feels.”

This article was produced by Popular magazinewhere a longer version of it appeared.

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