Transcript Walter R. Frontera, MD, PhD Professor and Chair

Walter R. Frontera, MD, PhD
Professor and Chair
Department of Physical Medicine and Rehabilitation
Vanderbilt University School of Medicine
And
Medical Director of Rehabilitation Services
Vanderbilt University Medical Center
No disclosures
“Old age is that period of life when more and more things happen for the last time
and fewer and fewer things happen for the first time.”
Anonymous
3
Age Structure of Population in Latin America
% 65 and over
2010
2030 (projection)
30.0
19.4
20.0
17.6
17.0
13.0
11.5
10.0
11.3
10.6
9.2
5.6
6.2
Colombia
Ecuador
6.8
6.0
13.9
10.2
6.87.5
6.0
4.3
0.0
Chile
Source: UN
Honduras
Mexico
Panama
Peru
Puerto Rico
Uruguay
Relative effort at the knee joint in
young and old healthy volunteers
young adult
old adult
100
75
50
25
0
Ascent
Descent
Chair rise
Modified from: Hortobagyi, et al. J Gerontol. 58A(5): 453-460, 2003; relative effort=%left knee extensor moment
during an ADL in relation to max knee ext. moment during supine leg press.
From: Gait Speed and Survival in Older Adults
JAMA. 2011;305(1):50-58. doi:10.1001/jama.2010.1923
Figure Legend:
A PDF of enlarged graphs is available.
Date of download: 12/30/2013
Copyright © 2012 American Medical
Association. All rights reserved.
From: A Diagnosis of Dismobility—Giving Mobility Clinical Visibility: A Mobility Working Group
Recommendation
JAMA. 2014;311(20):2061-2062. doi:10.1001/jama.2014.3033
Figure Legend:
Prevalence of Either Disability for Activities of Daily Living or Mobility Disability by Usual Gait Speed Among Men Aged 80 Years
(N = 6534)ADL indicates activities of daily living. Based on data from Guralnik and colleagues.
Date of download: 3/16/2015
Copyright © 2015 American Medical
Association. All rights reserved.
Centenarians
• Centenarian Singh
became the oldest
person to run a complete
marathon when he
finished a 26.2-mile race
in Toronto October 16,
2011.
9
Sarcopenia
Sarx = flex penia = loss
20 y/o (healthy)
75 y/o (healthy)
Muscle function in middle-aged and older men
(Reid et al., Eur. J. Appl. Physiol 112:2289, 2012)
*=significant overall group differences;
Muscle strength (tertiles) of the knee extensors before and mortality after a
bone fracture in older people
# deaths/1000 person months
From: Rantanen et al., SJMSS, 12:296, 2002.
EWGSOP-suggested algorithm for sarcopenia case finding in older individuals (Cruz-Jentoft A J et al. Age Ageing 2010;39:412423)
.
Prevalence of sarcopenia and sarcopenic obesity by levels of physical activity among respondents aged 65
years and older (weighted %). †P < 0.1, *P < 0.05, ***P < 0.001 (low activity as reference).
Ryu M et al. Age Ageing 2013;ageing.aft063
Physical activity among Hispanics
•
In the Latino population, physical inactivity
appears to be more prevalent among Hispanics
(37%), blacks (33%) and whites (22%)
•
All Hispanic groups were less active than were
non-Hispanic white individuals
•
Variability among sub-groups: Cuban and
Dominican participants were the least active
(19.8% met recommendation), whereas
Mexican American participants were the most
active (31.9% met recommendation).
•
Women were less active than were men across
all subgroups. Among Hispanic women, 74%
report that they do not participate in leisuretime physical activity, and this seems to decline
with age [14].
15
“There is perhaps nothing in
Nature older than motion”
Galileo
Exercise prescription
n muscles: knee extensors and
flexors
n type: progressive resistance
(dynamic)
n sequence: 3 sets / day / muscle
group, 6-9 s / repetition, 8 reps /
set
n intensity: 80% of 1 RM
n frequency: 3 days / week
n total duration: 12 weeks
% change
Strength (60 deg/s) & CSA (CT scan) of the extensors of the knee:
effects of aging & strength training
From: Frontera et al., JAP 64:1038, 1988 and JAP 88:1321, 2000
TNF-alpha Protein Content
(pg mg-1)
Resistance exercise and tumor necrosis factor  in
frail elderly humans
P<0.01
Baseline
P<0.01
Post-Training
Baseline
Greiwe et al. FASEB J 15:475-482, 2001
Post-Training
Long-term exercise in older adults: 4 year outcomes of music based
multitask training (Hars et al., CTI 95:393, 2014)
Continued training
Discontinued training
Additional anabolic strategies
• Diet
• high intake of amino acids – leucine
(>2g)
• high levels of total protein (25-30 g)
• blunted response to mixed meal
including carbohydrates (insulin
resistance?)
• coupling with exercise
Strength = m x a
Power = Force x distance
time
Dose-response relationship of resistance training in
older adults
 Meta-analysis of 29 randomized controlled
clinical trials with a total of 1313 subjects
 Strong effects of progressive resistance
training (PRT) on maximal strength in a dosedependent manner
 PRT was also successful for improving
functional outcomes but gains were
independent of training intensity
 Power training was more effective for
improving muscle power and functional
outcomes than PRT
Steib et al., MSSE 42:902-914, 2010
Low vs. high intensity power training in mobility-limited older
adults
 52 subjects (78+5 yrs)
 Randomized controlled trial low (40% of 1 RM) vs. high intensity (70% of
1 RM)
 Training






Leg extension and knee extension exercises
3 sets of 10 repetitions each
2 sessions per week
Total of 16 weeks
Concentric phase as quickly as possible
Resistance adjusted every 3 weeks
Reid, …. Frontera, Fielding, et al., J Gerontol 70:374, 2015
Low vs. high intensity power training in mobility-limited older
adults
LO 40%
HI 70%
50
42
40
34
30
22
19
20
16
13
10
1.4
1.8
0
1 RM
Peak power
Velocity
SPPB
Significant differences within groups but NOT between groups Reid, …. Frontera, Fielding, et al., J Gerontol 2014 (in press)
Embrace aging