Strength Balance and Function in
the Elderly
Chris Ingersoll, PhD
D. Casey Kerrigan, MD
Phil Rowland, BS
Jason Rutkowski, MS
Arthur Weltman, PhD
Institute on Aging, General Clinical Research Center,
Kinesiology, Physical Medicine and Rehabilitation
University of Virginia
ACAC
Making our Community a Better Place to Age – April 13, 2007
Introduction
• Maintaining independent living and high quality of
life are important for the elderly
• Compelling evidence exists regarding the benefits of
physical activity programs for the elderly
• However, information regarding optimized programs
integrating strength, balance and function for the
elderly is lacking
Making our Community a Better Place to Age – April 13, 2007
Making our Community a Better Place to Age – April 13, 2007
“Every day you get older. It’s the law”
Sundance Kid to Butch Cassidy
Making our Community a Better Place to Age – April 13, 2007
Making our Community a Better Place to Age – April 13, 2007
Sarcopenia
Age related loss of skeletal
muscle mass
Making our Community a Better Place to Age – April 13, 2007
Sarcopenia
• Reduced protein reserves
• Decreased strength and functional
capacity
– Frailty, Falls
• Reduced aerobic capacity
• Reduced energy requirements
Making our Community a Better Place to Age – April 13, 2007
Sarcopenia
• Reduced levels of physical activity
• Loss of motor units (aging CNS)
• Reduced rate of muscle protein
synthesis
– changing endocrine function (testosterone,
estrogen, growth hormone)
• Increased dietary protein needs
Making our Community a Better Place to Age – April 13, 2007
Sarcopenia
Basal
Basal Metabolic
Metabolic
Rate
Rate
Activity
Strength
Strength
Frailty
V O2max
2max
Bone
Bone Density
Density
Energy
Energy Needs
Needs
Body Fat
Making our Community a Better Place to Age – April 13, 2007
Osteoporosis
Osteoporosis
Making our Community a Better Place to Age – April 13, 2007
VO2max of sedentary 75 year old woman
compared to O2 cost of activities
VO2max
Run (6.5 mph)
Cleaning
Climb Stairs
Walk (2.5 mph)
0
0.25 0.5
0.75
1
1.25 1.5
1.75
2
2.25 2.5
Oxygen consumption (L/min)
Making our Community a Better Place to Age – April 13, 2007
Age-related changes in thigh
cross-sectional area
21 year old woman
63 year old woman
Making our Community a Better Place to Age – April 13, 2007
Impaired Strength
Inability to lift 4.5 kg
Jette, Am. J. Public Health, 71, 1981
70
60
50
%
Men
Women
40
30
20
10
0
55-65
65-75
Making our Community a Better Place to Age – April 13, 2007
75-85
Death Rates According to Individual
Performance Tests—Age and Sex Adjusted
Test Category
0
1
2
3
4
Walk
% Distribution 5 23 25 26 22
0
1
2
3
4
Chair Stands
22 19 20 20 19
Making our Community a Better Place to Age – April 13, 2007
0
1
2
3
4
Standing Balance
10 15 13 14 49
Aerobic Exercise and Aging: Does aging effect
the adaptation to aerobic exercise training?
Making our Community a Better Place to Age – April 13, 2007
60
VO2max (ml•kg-1•min-1)
Pre-Training
50
Post-Training
40
30
20
10
0
OLD
Old (60-70)
YOUNG
Young (20-30)
Making our Community a Better Place to Age – April 13, 2007
Older men and women experience a greater
relative increase in aerobic capacity as a result
of 12 weeks of aerobic exercise training
YOUNG
(age 20-30)
OLD
(age 60-70)
0
10
20
% Change in VO2 max
Meredith, CN, et al. Peripheral effects of endurance training in young and old subjects. J Appl
Physiol 66(6):2844-2849, 1989.
Making our Community a Better Place to Age – April 13, 2007
Resistance Exercise
Making our Community a Better Place to Age – April 13, 2007
50
*
40
*
PRE-TRAINING
MID-TRAINING
POST-TRAINING
30
1 RM
*
*
20
10
0
EXTENSORS
Extensors
FLEXORS
Flexors
Frontera, WR, et al Strength conditioning in older men: Skeletal muscle
function and mass. J Appl Physiol 64:1038-1044, 1988.
Making our Community a Better Place to Age – April 13, 2007
Control
Exercise
2000
Activity
(kcal/week)
1000
0
Pre
Pre
Pre Training
Training
Post
Post
Post Training
Training
Making our Community a Better Place to Age – April 13, 2007
In very old nursing home
residents, 10 weeks of
progressive resistance
exercise training
•Increased walking
speed
•Increased stair climbing
ability
•Increased spontaneous
activity
•Decrease in depressive
symptoms
Making our Community a Better Place to Age – April 13, 2007
The Effects of an Aggressive Balance Program
on Strength, Balance and Function
Balance Group
Control Group
Age
73.3
71.7
BMI
25.3
24.6
Making our Community a Better Place to Age – April 13, 2007
Making our Community a Better Place to Age – April 13, 2007
Making our Community a Better Place to Age – April 13, 2007
Making our Community a Better Place to Age – April 13, 2007
Making our Community a Better Place to Age – April 13, 2007
Making our Community a Better Place to Age – April 13, 2007
Making our Community a Better Place to Age – April 13, 2007
Strength
(NM)
180
Knee
Trunk
120
160
100
140
120
80
Control
Balance
100
80
60
40
40
20
20
0
60
Flex
Ext
0
Flex
Making our Community a Better Place to Age – April 13, 2007
Ext
Balance
90
85
80
75
Control
Balance
70
65
60
55
50
Path Length (cm)
Making our Community a Better Place to Age – April 13, 2007
Function
16
18
15.5
15
Time
(seconds)
Control
Balance
16
30 m Walk
14
2040
2020
2000
1980
12
Distance (feet)
6-min walk
Time (seconds)
Sit to Stand
Making our Community a Better Place to Age – April 13, 2007
5 times
Helen Zechmeister, Age 81, Weight Lifter
Making our Community a Better Place to Age – April 13, 2007
Woody Brown
Age 83
Surfer
Making our Community a Better Place to Age – April 13, 2007
John Turner:
Age 67
Weight Lifter
Making our Community a Better Place to Age – April 13, 2007
Making our Community a Better Place to Age – April 13, 2007
Making our Community a Better Place to Age – April 13, 2007