Title: Exercise helps to preserve muscle function into old age


Key words: exercise, old age, geriatric, muscle function, sarcopenia, ageing, aging, inactivity, grip strength, cardiovascular function, aerobic capacity, fitness, function, muscle fibre, strength, mobility, endurance, oxidative capacity, aerobic training, resistance training, balance, repetitions, flexor, extensor, spine, pelvis, shoulder, walking, running, cycling,  


Date: Oct 2006




Nutrimed Module:


Type: Article


Author: Morgan, G


Exercise helps to preserve muscle function into old age

Loss of muscle power and function, and increasing disability are concomitants of ageing. Increasing muscle disuse associated with ageing is the major precipitating factor. This review will look at the ability of rehabilitation programmes to stem or reverse this decline.

The increasing level of inactivity associated with ageing is apparent from surveys. One survey showed that 49% of women and 27% of men over the age of 70 in the US had substantial work or mobility limitations (Pinsky 1990). Another that in a 55-87 year old age group, 53% of those engaged in any form of sport discontinued it over a 3-year period (Visser 2002).


Grip strength correlates with general muscle power (Giampaoli 1999) and has been found to decrease with age, to the point where 28% of men and 66% of women over the age of 74 were unable to lift a weight greater than 4.5 Kg. (Jette 1981). Diminishing leg strength, correspondingly, leads to an increased incidence of falls (Baumgartner 1998, Day 2002), loss of balance and mobility (Wolfson 1995, Pinsky 2002). Increasing disability, in its train, leads to poorer cardiovascular function and increased morbidity (Pinsky 2002).


Loss of muscle power is associated with muscular wasting (Frontera 1991), which is progressive with age in the non-active (Tsankoff 1977). Muscular atrophy is directly related to a loss of muscle fibre numbers and muscle cross-sectional area (Lexell 1988). Loss of muscle is accompanied by reduction in muscular capillary density and aerobic capacity – both strength and fitness therefore diminish with age (Fleg 1988, Coggan 1992, McGuire 2001a). Even among lifelong master athletes some loss of function is inevitable: in this group aerobic capacity has been found to deteriorate by 5-10% per decade (Pollock 2002). This is wholly down to loss of muscle strength and its oxidative capacity and not to any fall off in cardiac output (Coggan 1992).


Against this background of progressive decline, there is now a large body of research showing a muscular adaptive response that can be maintained into advanced old age. The conclusion of this work is that strength; mobility and endurance capacity is most benefited by resistance type training. Such programmes bring about increases in muscle cross-sectional area, fat free mass, with increases in strength and endurance (Larrson 1982, Frontera 1988, Fiatarone 1994, Ades 1996). Peripheral oxidative capacity is improved through expansion of the muscular capillary network with an improvement in aerobic capacity (Frontera 1988, Coggan 1992, McGuire 2001b). Aerobic training is less effective – a minimum of 4 hours of walking a week has produced improvements in leg strength, mobility, and aerobic fitness and led to a reduction in cardiovascular disease (LaCroix 1996). Muscle mass remains unchanged, however, with this type of activity, with up to 12 months of relatively high intensity aerobic conditioning producing no additional benefit (Coggan 1992). All trials, whether strength or endurance based, have shown no great changes in fibre-type composition, in spite of ageing being characterised by a more selective loss of type II fibres (Frontera 1988, Coggan 1992).


Through its ability to increase muscle mass, resistance training has been shown to increase strength, mobility and balance and reduce the incidence of falls in the elderly (Campbell 1997, Baumgartner 1998, Day 2002). Comparison of different regimes confirms that, in this respect, higher intensities of training are more beneficial. Thus training to 80% of one maximal repetition (1RM) is more beneficial than training to 66% of this maximum (Moritani 1980, Frontera 1988). This conclusion has been embodied in the position stand of the American College of Sports Medicine (1990), which states that such training leads to maximum strength gains with greater levels of mobility and cardiovascular fitness.


From a practical viewpoint, supervised sessions in a group environment appear to produce the best results. Isotonic exercises that exercise the main flexor and extensor groups of the upper and lower extremities, with strengthening exercises for the shoulder, spine and pelvis, all 3 times a week, 3 sets of 8 repetitions at 80% of 1RM, have led to strength gains of 5% per session (Frontera 1988). These are remarkable results. Home programmes have been devised but tend to be less effective due to compliance problems (Campbell 1997). Walking is less beneficial but may be more acceptable for certain groups. This and other forms of aerobic activity are to be encouraged, both from mobility and a cardiovascular point of view. The critical role played by activity is illustrated by a group of middle aged subjects who were bed rested for 3 weeks and then were retested for cardiovascular fitness 30 years later - the loss in fitness over those 3 weeks was shown to be significantly greater than in the subsequent 30 years of low activity (McGuire 2001a). All forms of activity, but particularly structured resistance activities, are, therefore, likely to be beneficial for the aged.



1. Pinsky JL, Jette AM, Branch LG, Kannel WB, Feinleib AB (1990) The Framingham Disability Study: relationship of various coronary heart disease manifestations to disability in older persons living in the community. Am J Public Health 80: 1363-7

2. Visser M, Pluijm SMF, Stel VS, Bosscher RJ, Deeg DJH (2002) Physical activity as a determinant of change in mobility performance: The Longitudinal Aging Study Amsterdam. J Am Geriatr Soc 50: 1774-1781

3. Giampaoli S, et al. (1999) Hand-grip strength predicts disability in non- disabled older men. Age & Ageing 28: 283-88

4. Jette AM, Branch LG (1981) The Framingham Disability Study: II. Physical disability among the aging. Am J Public Health 71: 1211-16

5. Baumgartner RN, et al. (1998) Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol 147: 755-63

6. Day L, et al. (2002) Randomised factorial trial of falls prevention among older people living in their own homes. BMJ 325: 128-131

7. Wolfson L, Judge J, Whipple R, King M (1995) Strength is a major factor in balance, gait and the occurrence of falls. J Gerontol SeriesA: Biological & Medical Sciences 50: 64-67

8. Frontera WR, Hughes VA, Lutz KJ, Evans WJ (1991) A cross-sectional study of muscle strength and mass in 45- to 78-year old men and women. J Appl Physiol 64: 1038-44

9. Tzankoff SP, Norris AH (1977) Effect of muscle mass decrease on age-related BMR changes. J Appl Physiol 43:1001-06

10. Lexell J, Taylor CC, Sjostrom M (1988) What is the cause of the aging atrophy. J Neurol Sci 84: 275-94

11. Fleg JL, Lakatta EG (1988) Role of muscle loss in the age-associated reduction in VO2max. J Appl Physiol 65: 1147-51

12. Coggan AR, et al. (1992) Skeletal muscle adaptations to endurance training in 60- to 70-yr-old men and women. J Appl Physiol 72: 1780-86

13. McGuire DK, et al. (2001a) A 30-year follow-up of the Dallas bed rest and training study. I. Effect of age on cardiovascular response to exercise. Circulation 104: 1350-57

14. Pollock ML, et al. (1997) Twenty-year follow-up of aerobic power and body composition of older track athletes. J Appl Physiol 82:1508-16

15. Larsson L (1982) Ageing in mammalian skeletal muscles. In: Mortimer JA, Pirozzolo FJ, Maletta GJ, eds. The aging motor system. Advances in neurogerontology, Vol 3. New York: Praeger, pp 60-97

16. Frontera WR, Meredith CN, O’Reilly KP, Knuttgen HG, Evans WJ (1988) Strength conditioning in older men: skeletal muscle hypertrophy and improved function. J Appl Physiol 64: 1038-44

17. Fiatarone MA, et al. (1994) Exercise training and nutritional supplementation for physical frailty in elderly people. N Engl J Med 330: 1769-75

18. Ades PA, Ballor DL, Ashikaga T, Utton JL, Nair KS (1996) Weight training improves walking endurance in healthy persons. Ann Intern Med 124: 568-72

19. McGuire DK, et al. (2001b) A 30-year follow-up of the Dallas bed rest and training study. II. Effect of age on cardiovascular adaptation to exercise training. Circulation 104: 1358-66

20. LaCroix AZ, Leveille SG, Hecht JA, Grothaus LC, Wagner EH (1996) Does walking decrease the risk of cardiovascular disease hospitalizations and death in older adults? J Am Geriatr Soc 44: 113-120

21. Campbell AT, et al. (1997) Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. BMJ 315: 1065-9

22. Moritani T, de Vries HA (1980) Potential for gross muscular hypertrophy in older men. J Gerontol 35: 672-82

23. American College of Sports Medicine (1990) American College of Sports Medicine position stand: the recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. Med Sci Sports Exerc 22: 265-74