Role of the nervous system in sarcopenia and muscle atrophy with aging: strength training as a countermeasure

Age-related modifications to the magnitude and periodicity of neuromuscular noise

Background

Evaluation of task related outcomes within geriatric and fall-prone populations is essential not only for identification of neuromuscular deficits, but also for effective implementation of fall prevention strategies. As most tasks and activities of daily living are performed at submaximal force levels, restoration of muscle strength often does not produce the expected benefit in functional capacity. However, it is known that muscular control plays a key role in the performance of functional tasks, but it remains unclear to what degree muscular control and the associated neuromuscular noise (NmN) is age-related, particularly in the lower-extremities.

Objectives

The aim of this study was to determine the effects of age and fall-pathology on the magnitude as well as the frequency of NmN during lower extremity force production.

Methods

Sixteen young healthy adults, as well as seventy elderly women (36 healthy, 34 elderly fallers), performed force production tests at moderate levels (15% of maximum voluntary isometric contractions).

Results

Elderly fallers exhibited the highest magnitude of NmN, while the highest frequency components of NmN tended to occur in the healthy elderly. Young subjects exhibited significantly more power in the low frequency ranges than either of the elderly groups, and had the lowest levels of NmN.

Conclusion

These data suggest increased degeneration of muscular control through greater NmN in elderly fallers compared to healthy elderly or young subjects. This could possibly be associated with muscle atrophy and lower levels of motor unit synchronisation.

Comparing the reliability of voluntary and evoked muscle actions

PURPOSE

The purpose of this exploratory study was to quantify the test-retest reliability, intertrial variability and correlations between variables calculated during voluntary and evoked muscle actions.

METHODS

During three separate trials of isometric leg extension muscle actions with 14 men [mean age (± SD) = 21.9 (± 3.2) years; height = 179.2 (± 8.0) cm; mass = 77.7 (± 10.9) kg], peak torque (PT(V)), time to peak torque (TPT(V)), rate of torque development (RTD(V)), time to peak rate of torque development (TRTD(V)), electromechanical delay (EMD(V)) and EMG amplitude (EMG(RMS)) were quantified for voluntary muscle actions. Peak twitch torque (PTE ), time to peak twitch torque (TPT(E)), rate of torque development (RTD(E)), time to peak rate of torque development (TRTD(E)), electromechanical delay (EMD(E)), peak-to-peak M-wave (Mp-p) and M-wave area (M(area)) were calculated for evoked twitches. All electromyographic measurements were recorded over the vastus lateralis.

RESULTS

Voluntary intraclass correlation coefficients (ICC) were 0.84-0.96, except for TRTD(V) (0.30) and EMD(V) (0.74). Evoked ICC were 0.80-0.95, except for EMD(E) (0.52). Relative standard errors of measurement for TPT and TRT(D) were greater for voluntary than evoked, whereas the value for PTE was greater than PT(V). There were low to moderate correlations (r = -0.41-0.51) between common voluntary and evoked variables.

CONCLUSIONS

Evoked variables showed lower intertrial variability than voluntary. Overall, voluntary and evoked muscle actions provide unique, complimentary information regarding neuromuscular function that cannot be used interchangeably.

Human neuromuscular structure and function in old age: A brief review

Natural adult aging is associated with many functional impairments of the human neuromuscular system. One of the more observable alterations is the loss of contractile muscle mass, termed sarcopenia. The loss of muscle mass occurs primarily due to a progressive loss of viable motor units, and accompanying atrophy of remaining muscle fibers. Not only does the loss of muscle mass contribute to impaired function in old age, but alterations in fiber type and myosin heavy chain isoform expression also contribute to weaker, slower, and less powerful contracting muscles. This review will focus on motor unit loss associated with natural adult aging, age-related fatigability, and the age-related differences in strength across contractile muscle actions.

How to simultaneously optimize muscle strength, power, functional capacity, and cardiovascular gains in the elderly: an update

The purpose of the present study was to review the scientific literature that investigated concurrent training adaptations in elderly populations, with the aim of identifying the optimal combination of both training program variables (i.e., strength and endurance) to avoid or minimize the interference effect in the elderly. Scielo, Science Citation Index, MEDLINE, Scopus, SPORTDiscus, and ScienceDirect databases were searched. Concurrent training is the most effective strategy by which to improve neuromuscular and cardiorespiratory functions as well as functional capacity in the elderly. The volume and frequency of training appears to play a critical role in concurrent training-induced adaptations in elderly subjects. Furthermore, new evidence indicates that the intra-session exercise order may influence the magnitude of physiological adaptations. Despite the interference effect on strength gains that is caused by concurrent training, this type of training is advantageous in that the combination of strength and endurance training produces both neuromuscular and cardiovascular adaptations in the elderly. The interference phenomenon may be observed in elderly subjects when a moderate weekly volume of concurrent training (i.e., three times per week) is performed. However, even with the occurrence of this phenomenon, the performance of three concurrent training sessions per week appears to optimize the strength gains in relative brief periods of training (12 weeks). Moreover, performing strength prior to endurance exercise may optimize both neuromuscular and cardiovascular gains.

Motor unit

Movement is accomplished by the controlled activation of motor unit populations. Our understanding of motor unit physiology has been derived from experimental work on the properties of single motor units and from computational studies that have integrated the experimental observations into the function of motor unit populations. The article provides brief descriptions of motor unit anatomy and muscle unit properties, with more substantial reviews of motoneuron properties, motor unit recruitment and rate modulation when humans perform voluntary contractions, and the function of an entire motor unit pool. The article emphasizes the advances in knowledge on the cellular and molecular mechanisms underlying the neuromodulation of motoneuron activity and attempts to explain the discharge characteristics of human motor units in terms of these principles. A major finding from this work has been the critical role of descending pathways from the brainstem in modulating the properties and activity of spinal motoneurons. Progress has been substantial, but significant gaps in knowledge remain.

Isolation, characterization, and molecular regulation of muscle stem cells

Skeletal muscle has great regenerative capacity which is dependent on muscle stem cells, also known as satellite cells. A loss of satellite cells and/or their function impairs skeletal muscle regeneration and leads to a loss of skeletal muscle power; therefore, the molecular mechanisms for maintaining satellite cells in a quiescent and undifferentiated state are of great interest in skeletal muscle biology. Many studies have demonstrated proteins expressed by satellite cells, including Pax7, M-cadherin, Cxcr4, syndecan3/4, and c-met. To further characterize satellite cells, we established a method to directly isolate satellite cells using a monoclonal antibody, SM/C-2.6. Using SM/C-2.6 and microarrays, we measured the genes expressed in quiescent satellite cells and demonstrated that Hesr3 may complement Hesr1 in generating quiescent satellite cells. Although Hesr1- or Hesr3-single knockout mice show a normal skeletal muscle phenotype, including satellite cells, Hesr1/Hesr3-double knockout mice show a gradual decrease in the number of satellite cells and increase in regenerative defects dependent on satellite cell numbers. We also observed that a mouse's genetic background affects the regenerative capacity of its skeletal muscle and have established a line of DBA/2-background mdx mice that has a much more severe phenotype than the frequently used C57BL/10-mdx mice. The phenotype of DBA/2-mdx mice also seems to depend on the function of satellite cells. In this review, we summarize the methodology of direct isolation, characterization, and molecular regulation of satellite cells based on our results. The relationship between the regenerative capacity of satellite cells and progression of muscular disorders is also summarized. In the last part, we discuss application of the accumulating scientific information on satellite cells to treatment of patients with muscular disorders.

Effect of extracorporeal shock wave therapy on denervation atrophy and function caused by sciatic nerve injury

[Purpose] The present study examined the effects of treatment using extracorporeal shock wave therapy (ESWT) on the muscle weight and function of the hind limb in sciatic nerve injury. [Subjects] Forty rats with sciatic nerve crushing injury were randomly divided into two groups: an ESWT group (n=20), and a control group (n=20). [Methods] The ESWT group received extracorporeal shock wave treatment, and the control group did not receive any treatment after injury. Experimental animals were measured for muscle weight on an electronic scale and were tested for function on a sciatic functional index (SFI). [Results] All groups showed significant increases in the weights of the left soleus and gastrocnemius muscles, and decreases in the weights of the right soleus and gastrocnemius muscles (p<0.05). Comparison of SFI scores and muscle weights between the groups showed significant differences in SFI scores, and the right soleus and gastrocnemius muscles (p<0.05) [Conclusion] Exercise programs that use ESWT can be said to be effective at improving the function of the sciatic nerve and preventing the denervation atrophy.

Lean body mass and muscle function in head and neck cancer patients and healthy individuals--results from the DAHANCA 25 study

INTRODUCTION

Loss of lean body mass is common following radiotherapy in patients with head and neck squamous cell carcinoma (HNSCC) and may reduce maximal muscle strength and functional performance. However, the associations between lean body mass, muscle strength and functional performance are unclear and no studies in HNSCC patients have compared the levels of these variables to the levels seen in healthy individuals.

PURPOSE

The purpose of the present study was to investigate the associations between lean body mass, maximal muscle strength and functional performance in HNSCC patients and to compare the levels of these variables after radiotherapy and after progressive resistance training with the levels in healthy individuals.

MATERIAL AND METHODS

Lean body mass (dual energy X-ray absorptiometry), maximal muscle strength (isokinetic dynamometry) and functional performance (10 m max gait speed, 30 s chair rise, 30 s arm curl, stair climb) from HNSCC patients from the DAHANCA 25 trials and data from 24 healthy individuals were included.

RESULTS

Lean body mass and maximal muscle strength were significantly associated according to the gender and age-adjusted linear regression model (p < 0.0001). In addition, maximal muscle strength were associated with 30 s arm curl performance, 10 m max gait speed and 30 s chair rise (p < 0.0001). Multiple regression analyses showed that HNSCC patients expressed significant lower levels of the investigated variables after radiotherapy than healthy individuals (p < 0.0001), and that all differences were evened out after training.

CONCLUSIONS

Significant associations were found between lean body mass, maximal muscle strength and functional performance in HNSCC patients. Patients expressed lower levels of these variables compared with healthy individuals, suggesting that lean body mass is a clinically relevant health factor in HNSCC patients.

Does progressive resistance strength training as additional training have any measured effect on functional outcomes in older hospitalized patients? A single-blinded randomized controlled trial

OBJECTIVE

To evaluate the effect of progressive resistance strength training as additional training measured on functional outcomes in older hospitalized patients.

DESIGN

A single-blinded randomized controlled trial.

SETTING

Department of Geriatric Rehabilitation in university hospital.

PARTICIPANTS

A sample of 71 patients were successively included and randomized either to the treatment group (TG) (n = 36) or the control group (CG) (n = 35). Fifteen participants dropped out (TG n = 7; CG n = 8), leaving 56 participants with a mean age of 79 (SD 7).

INTERVENTION

Participants in the treatment group were treated in groups with progressive resistance strength training in addition to standard care. Progressive resistance strength training of the lower extremities was performed in three sets of 12-15 repetitions, intensity 60-70% of one repetition maximum, in four 50-minute sessions per week.

MAIN MEASURES

The effect was evaluated by timed up & go test, 30-second chair-stand test, 10-m walk test, three tasks (transfer, walking, stairs) of the Barthel Index, and use of walking aids.

RESULTS

Significant improvements in the 10-m walk test (P < 0.01) and Barthel Index (walking) (P = 0.01) were demonstrated within the treatment group but not in the control group. Both groups had significant improvements in timed up & go, 30-second chair-stand (modified) and Barthel Index (transfer and walking). No significant difference was found between groups except for the Barthel Index (stairs) (P = 0.05). Analysis by the mixed-effects model showed that the treatment group improved more than the control group in all outcome variables.

CONCLUSION

The results indicate that for older hospitalized patients progressive resistance strength training as additional training may have an effect compared to standard care, but no statistically significant effects were demonstrated when measured by functional outcomes.

The effect of progressive resistance training on lean body mass in post-treatment cancer patients - a systematic review

Loss of lean body mass is a common problem in many post-treatment cancer patients and may negatively affect physical capacity in terms of maximal muscle strength and functional performance. The purpose of this study was to systematically review the scientific evidence on the effect of progressive resistance training on lean body mass in post-treatment cancer patients. A comprehensive literature search was conducted and ultimately 12 studies were included. Methodological quality of the included studies was evaluated using the PEDro scale and the effect of progressive resistance training was reported as the range of mean changes among RCTs and non-RCTs. Six RCTs and six non-RCTs were included in the study. In the RCTs the change in lean body mass in the progressive resistance training groups relative to control groups ranged from -0.4% to 3.9%, and in four of six trials the training effect was significantly larger than the change in the control groups. In the six non-RCTs, the mean change in lean body mass over time ranged from -0.01 to 11.8% which was significant in two of the trials. The included studies reported no or very limited adverse events following progressive resistance training. Based on 12 heterogenic studies there is moderate evidence supporting a positive effect of progressive resistance training on lean body mass in post-treatment cancer patients.

In aged men, central vessel transmural pressure is reduced by brief Valsalva manoeuvre during strength exercise

A brief Valsalva manoeuvre, lasting 2-3 s, performed by young healthy men during strength exercise reduces transmural pressure acting on intrathoracic arteries. In this study, we sought to verify this finding in older men. Twenty normotensive, prehypertensive and moderately hypertensive otherwise healthy men 46-69 years old performed knee extensions combined with inspiration or with brief Valsalva manoeuvre performed at 10, 20 and 40 mmHg mouth pressure. Same respiratory manoeuvres were also performed at rest. Non-invasively measured blood pressure, knee angle, respiratory airflow and mouth pressure were continuously registered. In comparison to inspiration, estimated transmural pressure acting on thoracic arteries changed slightly and insignificantly during brief Valsalva manoeuvre at 10 and 20 mmHg mouth pressure. At 40 mmHg mouth pressure, transmural pressure declined at rest (-8·8 ± 11·4 mmHg) and during knee extension (-12·1 ± 11·9 mmHg). This decline ensued, as peak systolic pressure increase caused by this manoeuvre, was distinctly <40 mmHg. Only a main effect of mouth pressure was revealed (P<0·001) and neither exercise nor interaction between these factors, what suggests that transmural pressure decline, depended mainly on intrathoracic pressure developed during brief Valsalva manoeuvre. Resting blood pressure did not influence the effect of brief Valsalva manoeuvre on transmural pressure.

Role of peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α) in denervation-induced atrophy in aged muscle: facts and hypotheses

Aging-related loss of muscle mass, a biological process named sarcopenia, contributes to mobility impairment, falls, and physical frailty, resulting in an impaired quality of life in older people. In view of the aging of our society, understanding the underlying mechanisms of sarcopenia is a major health-care imperative. Evidence obtained from human and rodent studies demonstrates that skeletal muscle denervation/reinnervation cycles occur with aging, and that progressive failure of myofiber reinnervation is a major cause of the accelerating phase of sarcopenia in advanced age. However, the mechanisms responsible for the loss of myofiber innervation with aging remain unknown. The two major strategies that counteract sarcopenia, that is, caloric restriction and endurance training, are well known to protect neuromuscular junction (NMJ) integrity, albeit through undefined mechanisms. Interestingly, both of these interventions better preserve PGC-1α expression with aging, a transcriptional coactivator which has recently been shown to regulate key proteins involved in maintaining NMJ integrity. We therefore propose that the aging-related decline in PGC-1α may be a central mechanism promoting instability of the NMJ and consequently, aging-related alterations of myofiber innervation in sarcopenia. Similarly, the promotion of PGC-1α expression by both caloric restriction and exercise training may be fundamental to their protective benefits for aging muscle by better preserving NMJ integrity.

Sarcopenia: the gliogenic perspective

It has been approximately 25 years since Dr. Rosenberg first brought attention to sarcopenia. To date, this aging-associated condition is recognized as a chronic loss of muscle mass and is usually accompanied by dynapenia. Despite its poly-etiological factors, sarcopenia has a strong neurogenic component underlying this chrono-degeneration of muscle mass, as shown in recent studies. As it seems plausible to explain the origin of sarcopenia through a motor neuron degeneration model, the focus of sarcopenia research should combine neuroscience with the study of the original myocyte and satellite cells. Although a complete mechanism underlying the development of sarcopenia has yet to be elucidated, we propose that the primary trigger of sarcopenia could be gliogenic in origin based on the close relationship between the glia, neurons and non-neural cells, for example, the motor unit and its associated glia in both the central nervous system (CNS) and the peripheral nervous system (PNS). In addition to muscle cells, both of the neural cells are affected by aging.

Ageing is associated with diminished muscle re-growth and myogenic precursor cell expansion early after immobility-induced atrophy in human skeletal muscle

Recovery of skeletal muscle mass from immobilisation-induced atrophy is faster in young than older individuals, yet the cellular mechanisms remain unknown. We examined the cellular and molecular regulation of muscle recovery in young and older human subjects subsequent to 2 weeks of immobility-induced muscle atrophy. Retraining consisted of 4 weeks of supervised resistive exercise in 9 older (OM: mean age) 67.3, range 61-74 yrs) and 11 young (YM: mean age 24.4, range 21-30 yrs) males. Measures of myofibre area (MFA), Pax7-positive satellite cells (SCs) associated with type I and type II muscle fibres, as well as gene expression analysis of key growth and transcription factors associated with local skeletal muscle milieu, were performed after 2 weeks immobility (Imm) and following 3 days (+3d) and 4 weeks (+4wks) of retraining. OM demonstrated no detectable gains in MFA (vastus lateralis muscle) and no increases in number of Pax7-positive SCs following 4wks retraining, whereas YM increased their MFA (P < 0.05), number of Pax7-positive cells, and had more Pax7-positive cells per type II fibre than OM at +3d and +4wks (P < 0.05). No age-related differences were observed in mRNA expression of IGF-1Ea, MGF, MyoD1 and HGF with retraining, whereas myostatin expression levels were more down-regulated in YM compared to OM at +3d (P < 0.05). In conclusion, the diminished muscle re-growth after immobilisation in elderly humans was associated with a lesser response in satellite cell proliferation in combination with an age-specific regulation of myostatin. In contrast, expression of local growth factors did not seem to explain the age-related difference in muscle mass recovery.

Insulin resistance: a risk marker for disease and disability in the older person

Clinical metabolic studies have demonstrated that insulin action declines progressively with age in humans. In addition to its close association with Type 2 diabetes, which reduces life expectancy in older people, age-related insulin resistance is implicated in pathogenesis of several highly prevalent disorders for which ageing is a major risk factor. These include atherosclerotic cardiovascular disease, dementia, frailty and cancer. Accordingly, insulin resistance may be viewed as biomarker of age-related ill health and reduced lifespan. The rapidly rising number of older people, coupled with a high prevalence of insulin resistance resulting from obesity and sedentary lifestyles, presents unprecedented public health and societal challenges. Studies of centenarians have shown that preserved whole-body sensitivity to insulin is associated with longevity. The mechanisms through which insulin action is associated with age-related diseases remain unclear. Changes in body composition, i.e. sarcopenia and excess adiposity, may be more potent than age per se. Moreover, the impact of insulin resistance has been difficult to disentangle from the clustering of vascular risk factors that co-segregate with the insulin resistance-hyperinsulinaemia complex. Potentially modifiable mediators of age-related changes in insulin sensitivity include alterations in adipocytokines, impaired skeletal myocyte mitochondrial function and brown fat activity. The hypothesis that improving or maintaining insulin sensitivity preserves health and extends lifespan merits further evaluation. Practical non-pharmacological interventions directed against age-related insulin resistance remain underdeveloped. Novel metabolically active pharmacological agents with theoretical implications for some age-related disorders are entering clinical trials. However, recent adverse experiences with the thiazolidinediones suggest the need for a cautious approach to the use of insulin sensitizing drugs in older people. This could be particularly important in the absence of diabetes where the risk to benefit analysis may be less favourable.

Low- and high-volume strength training induces similar neuromuscular improvements in muscle quality in elderly women

The aim of this study was to compare the effects of low- and high-volume strength training on strength, muscle activation and muscle thickness (MT) of the lower- and upper-body, and on muscle quality (MQ) of the lower-body in older women. Twenty apparently healthy elderly women were randomly assigned into two groups: low-volume (LV, n=11) and high-volume (HV, n=9). The LV group performed one-set of each exercise, while the HV group performed three-sets of each exercise, twice weekly for 13 weeks. MQ was measured by echo intensity obtained by ultrasonography (MQEI), strength per unit of muscle mass (MQST), and strength per unit of muscle mass adjusted with an allometric scale (MQAS). Following training, there was a significant increase (p≤0.001) in knee extension 1-RM (31.8±20.5% for LV and 38.3±7.3% for HV) and in elbow flexion 1-RM (25.1±9.5% for LV and 26.6±8.9% for HV) and in isometric maximal strength of the lower-body (p≤0.05) and upper-body (p≤0.001), with no difference between groups. The maximal electromyographic activation for both groups increased significantly (p≤0.05) in the vastus medialis and biceps brachii, with no difference between groups. All MT measurements of the lower- and upper-body increased similarly in both groups (p≤0.001). Similar improvements were also observed in MQEI (p≤0.01), MQST, and MQAS (p≤0.001) for both groups. These results demonstrate that low- and high-volume strength training promote similar increases in neuromuscular adaptations of the lower- and upper-body, and in MQ of the lower-body in elderly women.

Hemin, heme oxygenase-1 inducer, attenuates immobilization-induced skeletal muscle atrophy in mice

AIMS

The present study examined the effect of the heme oxygenase (HO)-1 inducer hemin on skeletal muscle atrophy induced by single limb immobilization in mice.

MAIN METHODS

Immobilization was conducted in the left hindlimb of C57BL/6 mice for 1 week and the right hindlimb was used as a control. Hemin (30 mg/kg) was administered intraperitoneally once a day during the immobilization period. Gastrocnemius muscles were used for analysis. Muscle weight was measured to quantify degree of atrophy, and exhaustion treadmill test was performed to assess muscle function.

KEY FINDINGS

Immobilization increased HO-1 protein levels in skeletal muscle, which was further increased by hemin treatment. Immobilization induced weight loss and a functional reduction in skeletal muscle, which were attenuated by hemin treatment. Gene expression and protein levels of MuRF1 and atrogin-1 were increased by immobilization and hemin treatment attenuated the increment. The phosphorylation of mTOR and p70S6k was decreased by immobilization in skeletal muscle and hemin had no effect on mTOR and p70S6k phosphorylation. Gene expression of the antioxidants superoxide dismutase and glutathione peroxidase 1 in skeletal muscle was reduced by immobilization and hemin treatment recovered the reduction. Immobilization increased levels of carbonylated protein and nitrotyrosine in skeletal muscle, which was reversed by hemin treatment. Gene expression of inflammatory cytokines was increased by immobilization and was normalized as a result of hemin treatment.

SIGNIFICANCE

These results suggest that hemin attenuates immobilization-induced skeletal muscle atrophy through the suppression of protein degradation via its anti-oxidant and anti-inflammatory properties.

Effects of age and physical activity on response speed in knee flexor and extensor muscles

This study aims to determine the normalized response speed (V rn) in vastus lateralis (VL) and biceps femoris (BF) muscles in different age groups using tensiomyography. Eighty-four male subjects were divided into four age groups: teenage subjects (T); undergraduate students (U), adult subjects (A), and the elderly group (E). Differences in V rn were observed between E and T (p = 0.000), E and U (p = 0.000), and E and A (p = 0.018) for right VL and between E and T (p < 0.000) and U (p = 0.003) for left VL; between T and U (p = 0.010) and A (p = 0.000) for right VL, and A (p = 0.004) for left VL. V rn in the BF displayed different behavior from that of the VL, increasing moderately or stabilizing and declining slightly in E, in right leg (p = 0.020). The data obtained highlighted a decline in V rn for the VL in both legs with increasing age and, declines in BF response speed were observed only in E.

Upper extremity muscle volumes and functional strength after resistance training in older adults

Aging leads to a decline in strength and an associated loss of independence. The authors examined changes in muscle volume, maximum isometric joint moment, functional strength, and 1-repetition maximum (1RM) after resistance training (RT) in the upper extremity of older adults. They evaluated isometric joint moment and muscle volume as predictors of functional strength. Sixteen healthy older adults (average age 75 ± 4.3 yr) were randomized to a 6-wk upper extremity RT program or control group. The RT group increased 1RM significantly (p < .01 for all exercises). Compared with controls, randomization to RT led to greater functional pulling strength (p = .003), isometric shoulder-adduction moment (p = .041), elbow-flexor volume (p = .017), and shoulder-adductor volume (p = .009). Shoulder-muscle volumes and isometric moments were good predictors of functional strength. The authors conclude that shoulder strength is an important factor for performing functional reaching and pulling tasks and a key target for upper extremity RT interventions.

Stretch-shortening cycle muscle power in women and men aged 18-81 years: Influence of age and gender

This study explored the age-related deterioration in stretch-shortening cycle (SSC) muscle power and concurrent force-velocity properties in women and men across the adult life span. A total of 315 participants (women: n = 188; men: n = 127) aged 18-81 years performed maximal countermovement jumps on an instrumented force plate. Maximal SSC leg extension power expressed per kg body mass (Ppeak) was greater in men than in women across the adult age span (P < 0.001); however, this gender difference was progressively reduced with increasing age, because men showed an ∼50% faster rate of decline in SSC power than women (P < 0.001). Velocity at peak power (VPpeak) was greater in men than in women (P < 0.001) but declined at a greater rate in men than in women (P = 0.002). Vertical ground reaction force at peak power (FPpeak) was higher in men than in women in younger adults only (P < 0.001) and the age-related decline was steeper in men than in women (P < 0.001). Men demonstrated a steeper rate of decline in Ppeak than women with progressive aging. This novel finding emerged as a result of greater age-related losses in men for both force and velocity. Consequently, maximal SSC power production was observed to converge between genders when approaching old age.

Muscle strength rather than muscle mass is associated with standing balance in elderly outpatients

OBJECTIVES

Assessment of the association of muscle characteristics with standing balance is of special interest, as muscles are a target for potential intervention (ie, by strength training).

DESIGN

Cross-sectional study.

SETTING

Geriatric outpatient clinic.

PARTICIPANTS

The study included 197 community-dwelling elderly outpatients (78 men, 119 women; mean age 82 years).

MEASUREMENTS

Muscle characteristics included handgrip and knee extension strength, appendicular lean mass divided by height squared (ALM/height(2)), and lean mass as percentage of body mass. Two aspects of standing balance were assessed: the ability to maintain balance, and the quality of balance measured by Center of Pressure (CoP) movement during 10 seconds of side-by-side, semitandem, and tandem stance, with both eyes open and eyes closed. Logistic and linear regression models were adjusted for age, and additionally for height, body mass, cognitive function, and multimorbidity.

RESULTS

Handgrip and knee extension strength, adjusted for age, were positively related to the ability to maintain balance with eyes open in side-by-side (P = .011; P = .043), semitandem (P = .005; P = .021), and tandem stance (P = .012; P = .014), and with eyes closed in side-by-side (P = .004; P = .004) and semitandem stance (not significant; P = .046). Additional adjustments affected the results only slightly. ALM/height(2) and lean mass percentage were not associated with the ability to maintain standing balance, except for an association between ALM/height(2) and tandem stance with eyes open (P = .033) that disappeared after additional adjustments. Muscle characteristics were not associated with CoP movement.

CONCLUSION

Muscle strength rather than muscle mass was positively associated with the ability to maintain standing balance in elderly outpatients. Assessment of CoP movement was not of additional value.

Strength Training in the Elderly People

Proces starzenia się człowieka charakteryzuje się licznymi zmianami, które dotyczą struktur na poziomie molekularnym, komórkowym, narządowym oraz całego organizmu. Jednym ze skutków zmniejszającej się aktywności fizycznej oraz postępujących procesów starzenia się organizmu człowieka jest systematyczne obniżanie się siły mięśniowej, któremu towarzyszy pogorszenie sprawności w podstawowych czynnościach codziennych. Ćwiczenia fizyczne, w tym ćwiczenia ukierunkowane na zwiększenie siły mięśniowej, wykonywane przez osoby starsze spowalniają proces starzenia się i zapobiegają występowaniu wielu chorób. Jakkolwiek nawet stała i regularna aktywność fizyczna nie może zapobiec spadkowi siły wraz z wiekiem, to zmiany adaptacyjne w centralnym układzie nerwowym i mięśniowym wywołane stosowaniem ćwiczeń siłowych w dużym stopniu mogą rekompensować ten proces.

Ćwiczenia ukierunkowane na zwiększenie siły i masy mięśniowej, nazywane ćwiczeniami siłowymi, są na świecie powszechnie znane i stosowane przez ludzi w podeszłym wieku. W Polsce model usprawniania fizycznego osób starszych bazuje prawie wyłącznie na ćwiczeniach wytrzymałościowych i rozciągających, a stosowanie klasycznych ćwiczeń siłowych często wywołuje obawy.

Celem pracy jest uzasadnienie potrzeby stosowania ćwiczeń ukierunkowanych na zwiększenie siły mięśniowej w usprawnianiu osób starszych i przedstawienie efektów ich zastosowania.

New horizons in the pathogenesis, diagnosis and management of sarcopenia

Sarcopenia is the age-related loss of skeletal muscle mass and function. It is now recognised as a major clinical problem for older people and research in the area is expanding exponentially. One of the most important recent developments has been convergence in the operational definition of sarcopenia combining measures of muscle mass and strength or physical performance. This has been accompanied by considerable progress in understanding of pathogenesis from animal models of sarcopenia. Well-described risk factors include age, gender and levels of physical activity and this knowledge is now being translated into effective management strategies including resistance exercise with recent interest in the additional role of nutritional intervention. Sarcopenia is currently a major focus for drug discovery and development although there remains debate about the best primary outcome measure for trials, and various promising avenues to date have proved unsatisfactory. The concept of 'new tricks for old drugs' is, however, promising, for example, there is some evidence that the angiotensin-converting enzyme inhibitors may improve physical performance. Future directions will include a deeper understanding of the molecular and cellular mechanisms of sarcopenia and the application of a lifecourse approach to understanding aetiology as well as to informing the optimal timing of interventions.

Discrepancy in the involution of the different neural loops with age

The purpose of the study was to compare the effects of sensory manipulations on postural control for subjects of different ages. A young group of subjects (n = 17; 20.0 ± 1.3 years) and an old group of subjects (n = 17; 74.7 ± 6.3 years) were compared in 14 postural conditions [2 reference conditions and 12 sensory manipulation conditions: eyes closed, cervical collar, tendon vibration, electromyostimulation, galvanic vestibular stimulation (2 designs), foam surface] on a force platform. Spatio-temporal parameters of the center of foot pressure displacement were analyzed. When vestibular or proprioceptive afferences were manipulated, the old group was more disturbed than the young group. In addition, when myo-articular proprioceptive afferences were the only non-manipulated information source, the old group was also more disturbed than the young group. Hence, the inability to correctly interpret proprioceptive information and/or the impairment of myo-articular information would appear to be the major factor causing postural control deterioration. Moreover, concerning the vestibular system, it may be that aging alters the central integration of vestibular afferences. These results suggest that aging differently affects the functional ability of the different neural loops in postural control.

Efeito agudo de diferentes intensidades de exercício com pesos no desempenho muscular de idosas treinadas

O objetivo do presente estudo foi comparar a resposta aguda da sustentabilidade das repetições e do volume de sessões de exercício com pesos realizados com diferentes intensidades, em idosas treinadas. Fizeram parte deste estudo 16 idosas (68,3 ± 6,0 anos; 69,8 ± 10,6kg; 157,6 ± 6,5cm). Após a determinação das cargas referentes a 15 repetições máximas (RM) no exercício leg press, duas sessões experimentais (intervaladas por 48-72 horas) foram conduzidas adotando-se uma de duas diferentes intensidades (90 ou 100% de 15 RM). Um delineamento cross over balanceado foi utilizado para determinar a ordem das sessões. A sessão com 100% de 15 RM envolveu a realização de três séries até a fadiga muscular, ao passo que a sessão com 90% de 15 RM foi realizada em duas séries com 15 repetições e uma última até a fadiga muscular. O intervalo de recuperação entre as séries foi 120 segundos. O volume de treino obtido com 90% de 15 RM foi 22,5% superior (P < 0,01) ao volume da sessão realizada com 100% de 15 RM. A sustentabilidade das repetições no exercício realizado a 100% de 15 RM foi comprometida nas duas séries finais da sessão (P < 0,01), com diferenças em relação ao protocolo realizado com menor intensidade. A análise dos resultados sugere que reduções de 10% da carga de 15 RM têm efeito significativo na sustentabilidade do número de repetições entre as séries e volume de treino de idosas treinadas quando comparadas ao exercício realizado a 100% de 15 RM.

Sarcopenia in older adults

PURPOSE OF REVIEW

Sarcopenia, or the decline of skeletal muscle tissue with age, is one of the most important causes of functional decline and loss of independence in older adults. The purpose of this article is to review the current definitions of sarcopenia, its potential causes and clinical consequences, and the potential for intervention.

RECENT FINDINGS

Although no consensus diagnosis has been reached, sarcopenia is increasingly defined by both loss of muscle mass and loss of muscle function or strength. Its cause is widely regarded as multifactorial, with neurological decline, hormonal changes, inflammatory pathway activation, declines in activity, chronic illness, fatty infiltration, and poor nutrition, all shown to be contributing factors. Recent molecular findings related to apoptosis, mitochondrial decline, and the angiotensin system in skeletal muscle have highlighted biological mechanisms that may be contributory. Interventions in general continue to target nutrition and exercise.

SUMMARY

Efforts to develop a consensus definition are ongoing and will greatly facilitate the development and testing of novel interventions for sarcopenia. Although pharmaceutical agents targeting multiple biological pathways are being developed, adequate nutrition and targeted exercise remain the gold standard for therapy.

Genomic and proteomic profiling reveals reduced mitochondrial function and disruption of the neuromuscular junction driving rat sarcopenia

Molecular mechanisms underlying sarcopenia, the age-related loss of skeletal muscle mass and function, remain unclear. To identify molecular changes that correlated best with sarcopenia and might contribute to its pathogenesis, we determined global gene expression profiles in muscles of rats aged 6, 12, 18, 21, 24, and 27 months. These rats exhibit sarcopenia beginning at 21 months. Correlation of the gene expression versus muscle mass or age changes, and functional annotation analysis identified gene signatures of sarcopenia distinct from gene signatures of aging. Specifically, mitochondrial energy metabolism (e.g., tricarboxylic acid cycle and oxidative phosphorylation) pathway genes were the most downregulated and most significantly correlated with sarcopenia. Also, perturbed were genes/pathways associated with neuromuscular junction patency (providing molecular evidence of sarcopenia-related functional denervation and neuromuscular junction remodeling), protein degradation, and inflammation. Proteomic analysis of samples at 6, 18, and 27 months confirmed the depletion of mitochondrial energy metabolism proteins and neuromuscular junction proteins. Together, these findings suggest that therapeutic approaches that simultaneously stimulate mitochondrogenesis and reduce muscle proteolysis and inflammation have potential for treating sarcopenia.

Increased residual force enhancement in older adults is associated with a maintenance of eccentric strength

Despite an age-related loss of voluntary isometric and concentric strength, muscle strength is well maintained during lengthening muscle actions (i.e., eccentric strength) in old age. Additionally, in younger adults during lengthening of an activated skeletal muscle, the force level observed following the stretch is greater than the isometric force at the same muscle length. This feature is termed residual force enhancement (RFE) and is believed to be a combination of active and passive components of the contractile apparatus. The purpose of this study was to provide an initial assessment of RFE in older adults and utilize aging as a muscle model to explore RFE in a system in which isometric force production is compromised, but structural mechanisms of eccentric strength are well-maintained. Therefore, we hypothesised that older adults will experience greater RFE compared with young adults. Following a reference maximal voluntary isometric contraction (MVC) of the dorsiflexors in 10 young (26.1±2.7y) and 10 old (76.0±6.5y) men, an active stretch was performed at 15°/s over a 30° ankle joint excursion ending at the same muscle length as the reference MVCs (40° of plantar flexion). Any additional torque compared with the reference MVC therefore represented RFE. In older men RFE was ∼2.5 times greater compared to young. The passive component of force enhancement contributed ∼37% and ∼20% to total force enhancement, in old and young respectively. The positive association (R² = 0.57) between maintained eccentric strength in old age and RFE indicates age-related mechanisms responsible for the maintenance of eccentric strength likely contributed to the observed elevated RFE. Additionally, as indicated by the greater passive force enhancement, these mechanisms may be related to increased muscle series elastic stiffness in old age.

Biomarkers of sarcopenia in clinical trials-recommendations from the International Working Group on Sarcopenia

Sarcopenia, the age-related skeletal muscle decline, is associated with relevant clinical and socioeconomic negative outcomes in older persons. The study of this phenomenon and the development of preventive/therapeutic strategies represent public health priorities. The present document reports the results of a recent meeting of the International Working Group on Sarcopenia (a task force consisting of geriatricians and scientists from academia and industry) held on June 7-8, 2011 in Toulouse (France). The meeting was specifically focused at gaining knowledge on the currently available biomarkers (functional, biological, or imaging-related) that could be utilized in clinical trials of sarcopenia and considered the most reliable and promising to evaluate age-related modifications of skeletal muscle. Specific recommendations about the assessment of aging skeletal muscle in older people and the optimal methodological design of studies on sarcopenia were also discussed and finalized. Although the study of skeletal muscle decline is still in a very preliminary phase, the potential great benefits derived from a better understanding and treatment of this condition should encourage research on sarcopenia. However, the reasonable uncertainties (derived from exploring a novel field and the exponential acceleration of scientific progress) require the adoption of a cautious and comprehensive approach to the subject.

Mass spectrometry-based proteomic analysis of middle-aged vs. aged vastus lateralis reveals increased levels of carbonic anhydrase isoform 3 in senescent human skeletal muscle

The age-related loss of skeletal muscle mass and associated progressive decline in contractile strength is a serious pathophysiological issue in the elderly. In order to investigate global changes in the skeletal muscle proteome after the fifth decade of life, this study analysed total extracts from human vastus lateralis muscle by fluorescence difference in-gel electrophoresis. Tissue specimens were derived from middle-aged (47-62 years) vs. aged (76-82 years) individuals and potential changes in the protein expression profiles were compared between these two age groups by a comprehensive gel electrophoresis-based survey. Age-dependent alterations in the concentration of 19 protein spots were revealed and mass spectrometry identified these components as being involved in the excitation-contraction-relaxation cycle, muscle metabolism, ion handling and the cellular stress response. This indicates a generally perturbed protein expression pattern in senescent human muscle. Increased levels of mitochondrial enzymes and isoform switching of the key contractile protein, actin, support the idea of glycolytic-to-oxidative and fast-to-slow transition processes during muscle aging. Importantly, the carbonic anhydrase (CA)3 isoform displayed an increased abundance during muscle aging, which was independently verified by immunoblotting of differently aged human skeletal muscle samples. Since the CA3 isoform is relatively muscle-specific and exhibits a fibre type-specific expression pattern, this enzyme may represent an interesting new biomarker of sarcopenia. Increased levels of CA are indicative of an increased demand of CO₂-removal in senescent muscle, and also suggest age-related fibre type shifting to slower-contracting muscles during human aging.

Power loss is greater following lengthening contractions in old versus young women

Compared with isometric and dynamic velocity-constrained (isokinetic) tasks, less is known regarding velocity-dependent (isotonic) muscle power and recovery in older adults following repeated fatiguing lengthening contractions. We investigated voluntary and evoked neuromuscular properties of the dorsiflexors in nine old (68.3 ± 6.1 years) and nine young women (25.1 ± 1.3 years) during and following 150 lengthening contractions for up to 30 min of recovery. At baseline, the old were ~21% weaker for maximum isometric voluntary contraction (MVC) torque (P < 0.05), ~21% slower for peak loaded shortening velocity (P < 0.05), and ~39% less powerful compared with the young (P < 0.05). Following the task, MVC torque was depressed equally (~28%) for both groups (P < 0.05), but power was reduced ~19% in the old and only ~8% in the young (P < 0.05). Both measures remained depressed during the 30-min recovery period. Peak twitch torque (P (t)) was ~50% lower in the old at task termination, whereas the young were unchanged. However, by 5 min of recovery, P (t) was reduced similarly (~50%) in both groups, and neither recovered by 30 min. The old were affected more by low-frequency torque depression than the young, as shown by the ~40% and ~20% decreases in the stimulated 10:50 Hz ratio at task termination respectively, whereas both groups were affected similarly (~50%) 5 min into recovery, and neither recovered by 30 min. Thus, the coexistence of fatigue and muscle damage induced by the repetitive lengthening contractions impaired excitation-contraction coupling and cross-bridge function to a greater extent in the old, leading to a more pronounced initial loss of power than the young for up to 10 min following the exercise However, power remained blunted in both groups during the 30-min recovery period. These results indicate that older women are more susceptible to power loss than young following lengthening contractions, likely owing to a greater impairment in calcium kinetics.

Skeletal muscle power: a critical determinant of physical functioning in older adults

Muscle power declines earlier and more precipitously with advancing age compared with muscle strength. Peak muscle power also has emerged as an important predictor of functional limitations in older adults. Our current working hypothesis is focused on examining lower extremity muscle power as a more discriminant variable for understanding the relationships between impairments, functional limitations, and resultant disability with aging.

Differences in transcriptional patterns of extracellular matrix, inflammatory, and myogenic regulatory genes in myofibroblasts, fibroblasts, and muscle precursor cells isolated from old male rat skeletal muscle using a novel cell isolation procedure

Aged skeletal muscle displays increased fibrosis and impaired regeneration. While it is not well characterized how skeletal muscle fibroblasts contribute to these phenomena, transforming growth factor-β1 (TGF-β1) and Delta/Notch signaling have been implicated to influence muscle regeneration. In this study, a unique combination of aging phenotypes is identified in differentiating fibroblasts (myofibroblasts), proliferating fibroblasts, and muscle precursor cells (MPCs) that characterize an impaired regenerative potential observed in aged skeletal muscle. Using a novel dual-isolation technique, that isolates fibroblasts and MPCs from the same rat skeletal muscle sample, and cell culture conditions of 5 % O(2) and 5 % CO(2), we report for the first time that myofibroblasts from 32-mo-old skeletal muscle, compared to 3-mo-old, display increased levels of mRNA for the essential extracellular matrix (ECM) genes, collagen 4α1 (83 % increase), collagen 4α2 (98 % increase), and laminin 2 (113 % increase), as well as increased levels of mRNA for the inflammatory markers, interleukin-6 (4.3-fold increase) and tumor necrosis factor α (3.2-fold increase), and TGF-β1 (84 % increase), whose protein controls proliferation and differentiation. Additionally, we demonstrate that proliferating fibroblasts from 32-mo-old skeletal muscle display increased levels of mRNA for the Notch ligand, Delta 1 (≥2.0-fold increase). Together, these findings suggest that increased expression of ECM and inflammatory genes in myofibroblasts from 32-mo-old skeletal muscle may contribute to the fibrogenic phenotype that impairs regeneration in aged skeletal muscle. Furthermore, we believe the novel dual-isolation technique developed here may be useful in studies that investigate communications among MPCs, fibroblasts, and myofibroblasts in skeletal muscle.

Inducible nitric oxide synthase (iNOS) in muscle wasting syndrome, sarcopenia, and cachexia

Muscle atrophy—also known as muscle wasting—is a debilitating syndrome that slowly develops with age (sarcopenia) or rapidly appears at the late stages of deadly diseases such as cancer, AIDS, and sepsis (cachexia). Despite the prevalence and the drastic detrimental effects of these two syndromes, there are currently no widely used, effective treatment options for those suffering from muscle wasting. In an attempt to identify potential therapeutic targets, the molecular mechanisms of sarcopenia and cachexia have begun to be elucidated. Growing evidence suggests that inflammatory cytokines may play an important role in the pathology of both syndromes. As one of the key cytokines involved in both sarcopenic and cachectic muscle wasting, tumor necrosis factor α (TNFα) and its downstream effectors provide an enticing target for pharmacological intervention. However, to date, no drugs targeting the TNFα signaling pathway have been successful as a remedial option for the treatment of muscle wasting. Thus, there is a need to identify new effectors in this important pathway that might prove to be more efficacious targets. Inducible nitric oxide synthase (iNOS) has recently been shown to be an important mediator of TNFα-induced cachectic muscle loss, and studies suggest that it may also play a role in sarcopenia. In addition, investigations into the mechanism of iNOS-mediated muscle loss have begun to reveal potential therapeutic strategies. In this review, we will highlight the potential for targeting the iNOS/NO pathway in the treatment of muscle loss and discuss its functional relevance in sarcopenia and cachexia.

Eccentric contraction-induced injury to type I, IIa, and IIa/IIx muscle fibers of elderly adults

Muscles of old laboratory rodents experience exaggerated force losses after eccentric contractile activity. We extended this line of inquiry to humans and investigated the influence of fiber myosin heavy chain (MHC) isoform content on the injury process. Skinned muscle fiber segments, prepared from vastus lateralis biopsies of elderly men and women (78 ± 2 years, N = 8), were subjected to a standardized eccentric contraction (strain, 0.25 fiber length; velocity, 0.50 unloaded shortening velocity). Injury was assessed by evaluating pre- and post-eccentric peak Ca(2+)-activated force per fiber cross-sectional area (F (max)). Over 90% of the variability in post-eccentric F (max) could be explained by a multiple linear regression model consisting of an MHC-independent slope, where injury was directly related to pre-eccentric F (max), and MHC-dependent y-intercepts, where the susceptibility to injury could be described as type IIa/IIx fibers > type IIa fibers > type I fibers. We previously reported that fiber type susceptibility to the same standardized eccentric protocol was type IIa/IIx > type IIa = type I for vastus lateralis fibers of 25-year-old adults (Choi and Widrick, Am J Physiol Cell Physiol 299:C1409-C1417, 2010). Modeling combined data sets revealed significant age by fiber type interactions, with post-eccentric F (max) deficits greater for type IIa and type IIa/IIx fibers from elderly vs. young subjects at constant pre-eccentric F (max). We conclude that the resistance of the myofilament lattice to mechanical strain has deteriorated for type IIa and type IIa/IIx, but not for type I, vastus lateralis fibers of elderly adults.