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Role of the physical therapy for sarcopenia Prevention and treatment of

sarcopenia in older people

Conference Paper · May 2015

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Ирина Караганова
University of Ruse Angel Kanchev
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 The 3rd International Virtual Conference on Advanced Scientific Results
Role of the physical therapy for sarcopenia
Prevention and treatment of sarcopenia in older people
Irina Karaganova
Faculty of Public Health and Health Care, Department of Public Health and Social Activities
University of Ruse „Angel Kanchev―
Ruse, Bulgaria
Abstract- Sarcopenia is the age-associated loss of skeletal muscle
mass and function. It is a serious clinical problem threatening
independence and quality of life of older peoples.
There is convincing evidence that the presence of sarcopenia in
older patients may lead to significant decrease in the physical
functioning, strength and health status. This leads to severe
effects on quality of life in elderly people since sarcopenia is the
most frequent cause of impaired mobility, disability and
increased risk of falls or mortality.
All this determined the need to have a clearer picture of ongoing
interventions to prevent and tackle of the frailty in old age.
For this reason, in the last years there is a significant increase in
research interest in the field of the pathogenesis, treatment,
clinical consequences and the socioeconomic burden of this
condition. The reduction of age-related frailty, disability and
suffering is a major priority of the health and social systems. The
general belief is that the physical activity can slow the loss of
skeletal muscle mass and function. The physical inactivity or a
decreased physical activity level is a part of the underlying
mechanisms of sarcopenia. Therefore physical activity can be
seen as an important factor to reverse or modify the development
of this condition.
In this report are presented different etiological factors and
prevention and treatment strategies against sarcopenia. One of
the main strategies is the strength training which, together with
other means of physical therapy plays a primordial role in
prevention and delaying progression of sarcopenia. The
resistance exercise offset the loss in muscle mass and strength
associated with aging, thereby improving functional capacity.
The current recommendations for physical exercise are that is
should be individualized and adapted according the personal
preference, comorbidities and other sensory limitations of the
adults.
Resistance exercises are to be performed on two or more non-
consecutive days per week, using a set of 8 – 10 exercises for the
whole body and at a moderate to vigorous level of intensity.
Keywords- Sarcopenia, Prevention, Physical therapy, Physical
exercise
I. INTRODUCTION
It is well established that the aging process is associated
with numerous changes in the human body. One of the most
significant age-related changes is associated with progressive
reduction in muscle mass, muscle strength and function [18].
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People who are physically inactive can lose as much as 3%
to 5% of their muscle mass per decade after age 30 [27].
The generic term for the loss of skeletal muscle mass,
quality, and strength that can lead to frailty in the elderly is
called sarcopenia [1, 23].
It is estimated that sarcopenia affects 30% of people over
the age of 60 and more than 50% of people over the age of 80
[7].
This is a major clinical problem for the older people and the
geriatrics and gerontology researchers [10].
Geriatric rehabilitation has typically focused on patients
with orthopedic issues such as hip fracture, joint replacement,
arterial hypertension, diabetes mellitus and cerebrovascular
accidents. Little is known about the prevention and treatment
of the sarcopenia in older people [20].
Sarcopenia is derived from the Greek word ―sarx‖ for flesh
and ―penia‖ for loss (M.S. John Pathy 2006). This condition is
characterized by progressive atrophy of the skeletal muscles
leading to adverse outcomes such as physical disability, poor
quality of life and disability [10].
Age-related loss of muscle mass and strength not only
deprives elderly people of the ability to perform the most basic
activities of daily living, but also vastly heightens the risk of
suffering severe injuries, traumas and even death from sudden
falls and other accidents [10].
The muscle weakness reduces general activity levels in
elderly individuals which in turn elevates the risk of
osteoporosis due to a decrease in overall mechanical loading of
the skeleton. At the same time, the sarcopenia is linked to an
increase in the risk of metabolic disorders such as diabetes type
II [6].
It is widely accepted, that increased mechanical loading of
the musculoskeletal system (e.g., resistive exercise) can have a
beneficial effect on the thropics of skeletal muscle and the
supporting function resulting in a significant reduction in the
risk of developing all of the above age-related problems [6].
The reasons why muscle mass and strength decline with
age are not fully understood. It is assumed that sarcopenia
arises from a variety of overlapping changes, which include
insulin resistance, changing endocrine function, chronic
diseases, inflammation, nutritional deficiencies and low levels
of physical activity [10].
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PHYSICAL FUNCTION
IMPAIRMENT
- Muscle weakness; - Skeletal muscle loss;
- Difficulty in walking; - Poor quality of muscle tissue.
- Poor balance;
- Low physical activity.
Figure 1. The relationship between sarcopenia, frailty and impairment of physical function [5]
Therefore, the prevention and treatment of this syndrome
require an integrated approach that incorporates dietary
strategies, hormone replacement, nutritional supplementation,
and above all physical exercise.
II. METHODS
The purpose of this paper is to present the importance of
the physical therapy and in particular of resistance training in
the prevention and treatment of sarcopenia in older people.
For the purpose of the present study were considered and
analyzed modern therapeutic approaches to prevention and
treatment of sarcopenia.
The analysis includes summaries of data of the several
leading clinical studies examining the effects of physical
exercise on skeletal muscle in the aged.
III. RESULTS
Although some age-related reduction physical functionality
is probably inevitable, there is a growing understanding that
changes in behaviours associated with aging, particularly the
declines in physical activity, contribute to muscle weakness in
old age [20].
There is compelling evidence that the regular physical
activity is essential to maintaining and improving of the muscle
function, while avoiding adverse consequences of the
sarcopenia [14].
The physical therapy of sarcopenia is relevant because
changes in muscle properties and performance can profoundly
affect an older person’s ability to walk, to self-service and to be
independent. This is particularly serious problem for frail older
people who have low adaptation possibilities and physiological
reserve and are vulnerable to small changes in their physical
status that can occur after an injury or illness [14].
Medical and Health Sciences - Health sciences
The 3rd International Virtual Conference on Advanced Scientific Results
May, 25. - 29. 2015, www.scieconf.com
SARCOPENIA FRAILTY
- Weight loss;
- Fatigue and a feeling of
exhaustion;
- Cognitive disorders;
- Sedentary lifestyle;
- Social isolation.
Although there other treatment options such as
pharmaceutical and nutritional supplements, the exercise
training is one of the most established treatment approaches for
sarcopenia [14].
A primary factor in sarcopenia is disuse of skeletal muscle,
resulting in atrophy. The reduction in muscle strength is
directly associated with loss of muscle mass. Inactivity may
also play a role, contributing to other factors affecting aging the
muscles, including:
 Neuromuscular realignment (changes in the motor
units and innervation of the fibers);
 Reduction in the growth factors;
 Changes in muscle protein synthesis [16].
The loss of spinal alpha motor neurons associated with
aging probably there a major contributor to sarcopenia, since a
reduction in neurological input is a well-established cause of
muscle atrophy [14].
The established link between the inactivity and the losses of
muscle mass and strength suggests that the physical activity
should be a compulsory element of the prevention and
treatment of sarcopenia. The physical therapy program should
include resistance exercises, exercise to increase of muscle
strength, functional training, as well as endurance and aerobic
training [24].
The strength training contribute not only to muscle
hypertrophy, but also leads to beneficial changes in
neuromuscular function [24].
It has been reported that, the resistance exercises to
positively influence the neuromuscular system, hormone
concentrations, and protein synthesis rate. Research has shown
that a program of progressive resistance training exercises can
increase protein synthesis rates in older adults in as little as two
weeks [27].
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To increases in muscle mass, strength and quality and also
a better neuromuscular adaptation, the exercise must contain
resistance training including several exercises circuits with the
70 – 90% of the one repetition maximum, with an exercise
predominantly eccentric and performed, at least, every two
non-consecutive days [2, 3, 13, 17, 21].
Research shows that, after a program of resistance training
is introduced, motor neuron firing and protein synthesis (which
are needed in building muscle mass) increase even in the
elderly [11, 22]. These changes indicate that it is possible to
rebuild muscle strength even at an advanced age [11].
Aerobic exercise delays the strength loss and phenotypic
changes produced during aging in muscle fibers, even at
moderated intensities [2, 13, 19]. This form of exercise has
shown to aid in increasing protein synthesis, an important
function in maintaining muscle mass and strength in the aging
population [25].
The other types of exercise interventions, involving gait,
balance, coordination and functional exercises, may also be
effective in reducing the risk and rate of falls as well as
improving balance in older people [9, 12, 24].
IV. CONCLUSIONS
The age-related loss of muscle strength and mass is a
common problem that increases the risk of injury and
disability in older people. Although most often seen in
physically inactive people, the sarcopenia is also common in
those who remain physically active throughout their lives.
However, there is reliable evidence that an appropriate
exercise program can improve strength in older people. The
physical activity, especially resistance exercise may slow and
reverse age-related decrease in muscle strength as well as
improve physical mobility.
The planned resistance training could be an effective
countermeasure to prevent or reduce the adverse effects of the
sarcopenia and improving the quality of life. Resistance
training enhances the strength, power and mobility function
and induces skeletal muscle hypertrophy.
Numerous studies have demonstrated convincing evidence
that resistance training can improve muscle strength and
improve the ability to perform tasks of daily living. Resistance
training is the most effective exercise for slowing the rate of
loss of muscle mass and maintaining or improving muscle
strength [4, 8, 12, 15, 26].
The physical activity should be personalized and adapted
to subject's age and disability. The exercise program must be
carefully selected to minimize the risk of an injury,
particularly in the elderly, but also ensure enough strong effect
to increase strength. The exercise interventions are carried out
two to three times per week. Since all exercise effects are
transient, the long-term exercise is very important [14, 27].
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