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Use it or lose it...



The aging process is commonly associated with a loss of muscle strength and power, and an overall decline in function and physical fitness, with the result being weakness. This is often seen as being a non-preventable aspect of the human timeline, which to some extent is true, however, that is not to say that this decline cannot be slowed. Thus, the question is whether a loss in muscle strength is directly related to ageing (and non-preventable), or whether it is due to reduced exercise and activity as the individual ages.


There are some components of age-related weakness that cannot be controlled for, with a 1-3% loss in arm and leg muscle strength for every year of age above 601. This loss in muscle strength and infiltration of fat has been found to be one of the major predictors of functional decline and loss of independence1. More importantly, strength training and physical activity has found to be a predictor for maintaining, and even IMPROVING, muscle strength in elderly populations 2. Although, we do lose muscle mass as we age, with regular exercise, it is possible to build strength and reverse this process (to a degree), leading to an overall improvement in quality of life and independence2. Along with maintenance of exercise, individuals who have led a relatively active life (compared to a sedentary individual), generally have a slower decline in muscle mass/function, overall mobility and strength. This is important to know, as much like investing in your superannuation is setting you up for comfortable retirement, so is going to the gym or going for a run or walk with your friend.


Figure 1. Graphical representation of muscle fibre strength preservation with exercise (from Maula et al. 2019)



Although we generally become less active as we age, there is still plenty of opportunity to exercise, however, this is not the case for a lot of the population. The 2016 Centre for Disease Control report found that in the preceding month, 27.5% of adults older than 50 and 35.3% of adults older than 75 reported no leisure physical activity time4. Such an extreme lack of physical activity leads to higher morbidity and mortality, and an overall poorer quality of life, which are exaggerated for the elderly as there are already several age-related changes occurring in their bodies (loss of balance, strength and endurance)4,5,6. With more than one-third of our elderly population (and over one quarter of our middle-aged population) doing ZERO activity in the last month, it is no surprise that our rate of chronic disease across the population continues to increase. As our population continues to age, it is important that we investigate why this is occurring, rather than just acknowledging the issue at hand. Exercise does not always have to be structured and specific, rather it can whatever gets somebody moving and sweating, and a few examples are listed below


· Walking groups with friends in the area – walking to get a coffee counts!

· Hiking whilst on away on a holiday

· Tai chi or pilates classes in the park or at a gym/physio

· Following a body weight strength program/video at home

· Trying to go for a swim when at the beach

· Walking the long way whilst going to an appointment


Maula et al., (2019) found that there were four main categories which influenced physical activity levels of individuals aged >65 (Table 1). These categories have both barriers and facilitators included in them and as such, are areas which both health professionals and close social supports can address in the goal of improving exercise levels.



Table

There are numerous barriers which can be addressed to help promote physical activity in the elderly. These range from exercising with the individual to providing positive reinforcement and educating them on the benefits of physical activity. A large number of the elderly population disconnect from society as they age, and exercise offers the ability to reconnect through social outings and improved energy levels. With improved social integration, physical activity can address the mental and social wellbeing of the elderly, as well as the physical.



References

1. Frontera, W. R., Reid, K. F., Phillips, E. M., Krivickas, L. S., Hughes, V. A., Roubenoff, R., & Fielding, R. A. (2008). Muscle fiber size and function in elderly humans: a longitudinal study. Journal of applied physiology (Bethesda, Md. : 1985), 105(2), 637–642.

2. Lopez, P., Pinto, R. S., Radaelli, R., Rech, A., Grazioli, R., Izquierdo, M., & Cadore, E. L. (2018). Benefits of resistance training in physically frail elderly: a systematic review. Aging clinical and experimental research, 30(8), 889–899.

3. McLeod, M., Breen, L., Hamilton, D. L., & Philp, A. (2016). Live strong and prosper: the importance of skeletal muscle strength for healthy ageing. Biogerontology, 17(3), 497–510.

4. Watson, K. B., Carlson, S. A., Gunn, J. P., Galuska, D. A., O'Connor, A., Greenlund, K. J., & Fulton, J. E. (2016). Physical Inactivity Among Adults Aged 50 Years and Older - United States, 2014. MMWR. Morbidity and mortality weekly report, 65(36), 954–958.

5. Lee, I. M., Shiroma, E. J., Lobelo, F., Puska, P., Blair, S. N., Katzmarzyk, P. T., & Lancet Physical Activity Series Working Group (2012). Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet (London, England), 380(9838), 219–229.

6. Carlson, S. A., Adams, E. K., Yang, Z., & Fulton, J. E. (2018). Percentage of Deaths Associated With Inadequate Physical Activity in the United States. Preventing chronic disease, 15, E38.

7. Maula, A., LaFond, N., Orton, E., Iliffe, S., Audsley, S., Vedhara, K., & Kendrick, D. (2019). Use it or lose it: a qualitative study of the maintenance of physical activity in older adults. BMC geriatrics, 19(1), 349.






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