# Exercise as it relates to Disease/Resistance training effects on muscle physiology in elderly postoperative patients

This Wikibook page is a fact sheet and analysis of "Resistance training induces qualitative changes in muscle morphology, muscle architecture and muscle function in elderly postoperative patients" by Suetta C, Anderson JL, Dalgas U, Berget J, Koskinen S, Aagaard P, Magnusson SP, Kjaer M (2008)
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## Background Information for the Research

Sarcopenia is the progressive loss of skeletal muscle mass and strength with the risk of adverse effects. There are multiple factors that cause sarcopenia such as age, diet, physical activity levels and disease status. Sarcopenia is also associated with other poor health consequences such as disability, mental disorders, decreased quality of life and death.
According to the World Health Organization (WHO) since 1970 to 2025 there will be a 200% growth in the elderly and older adults population. Although we cannot change the ageing populations there are other preventative strategies used to address sarcopenia and age related conditions. Resistance training has shown to be an effective way of preventing muscle atrophy and increasing strength. Diet is also another way of preventing muscle loss by increasing protein consumption, this helps with maintaining muscle mass and structure
This paper explores different types of postoperative rehabilitation methods to best prevent muscle atrophy and sarcopenia in an elderly population. It also highlights changes in muscle structure, architecture and function after completing the different exercise methods.

## Where is this research from?

This study was conducted by the Institute of Sports Medicine at the Bispebjerg University Hospital in Copenhagen, Denmark and was approved by the ethics committee in accordance with the Declaration of Helsinki. There are authors in this research that are employed by the University of Copenhagen. This could potentially create a bias towards their research and the results acquired.

## Type of Research

This study was a randomized controlled trial and the patients were stratified by age and gender. A randomized controlled trial is where subjects are randomly selected into groups. This type of method is used to prevent bias with subjects and researchers. Therefore, the results of the research should be a true indication of the intervention effects. In this study the interventions are the different types of exercise methods and the control is the subjects non-operated leg.

## What did the Research Involve

* Thirty six elderly patients that were scheduled for a unilateral hip replacement volunteered to take place in the study.
* All patients were randomly placed into one of three groups: 1 unilateral resistance training, 2) unilateral electrical stimulation and 3) standard rehabilitation.
* The resistance training group carried out a 12-week (3 days per week) unilateral progressive training program focusing on leg press and knee extension exercises
* The electrical stimulation group performed neuromuscular stimulation of the quadriceps muscle of the operated limb for 1 hour per day for 12 weeks
* The standard rehabilitative group conducted functional exercises without external loading focusing on improving mobility and strength.
* All tests were performed 1 week before operation, 5 and 12 weeks post-surgery and muscle biopsies were taken 2 days post-surgery.

## Basic Summary of Results

The results presented were a direct analysis of pre and post-surgery changes in muscle physiology due to the different postoperative rehabilitation methods used.
| Results | Resistance Training | Electrical Stimulation | Standard Rehabilitation |
| Maximal Muscle Strength | 30% increase in maximal muscle strength when compared to baseline tes | No change when compared to baseline test | No change when compared to baseline test |
| Muscle Fibre Cross Sectional Area | Increase in type I, IIa and IIx | No increase in type I, IIa or IIx | No increase in type I, IIa or IIx |
| Muscle Fibre Type | Increase in type I and IIa muscle fibres | Increase in type I but no increase in type IIa muscle fibres | No increase in either type of muscle fibres |
| Muscle Architecture | 22% increase in fibre pennation angle | No change when compared to baseline test | 11% decrease in fibre pennation angle |
| Maximal Stair Walking Power (W/Kg) | 35% increase in power output | 34% increase in power output | No change when compared to baseline test |

## Interpretation of Results

The researchers determined that resistance training is an effective way of increasing maximal muscle strength in elderly post-operative patients. Interestingly increases in the muscle function were due to increased muscle fiber size, increases in both type I and II muscle fibres and the fibre pennation angle. These results have also been shown in typically younger healthy individuals from resistance training.
In contrast these results were not achieved by neuromuscular electrical stimulation or standard rehabilitative exercises. Therefore, resistance training should be considered when prescribing exercise for elderly individuals or and any individual with sarcopenic symptoms. This approach to resistance training has been used to gain specific results for the research, but it is an unusual approach towards resistance training for an elderly population. Their resistance training program should focus on whole body functional movements that promote whole bodystrength.
At the time of this study it was the first to measure muscle fibre pennation angle, muscle fibre area, maximal dynamic strength and stair climbing power in combination with different rehabilitative exercise interventions for elderly individuals. Recent research is looking into the role of the nervous system and how it is influencing sarcopenia and then how resistance training can prevent sarcopenia. Resistance training is having long term changes in skeletal muscle function and the neuromuscular system which can compensate for the age related declines in muscle size and nerve function

## Conclusions that should be taken away from this research

Resistance training has been shown to be an effective exercise method to help prevent the age related decline of muscle mass and help build muscular strength. These increases in muscle strength and function can have benefits on activities of daily living such as stair climbing and falls prevention

## Implications of the research

Resistance training can be used as a tool in preventing sarcopenia however; sarcopenia should be also be managed by other possible avenues such as diet, neuromuscular training, hormone replacement therapy and pharmacotherapies. These should all be considered when dealing with sarcopenia. It is important to note that appropriate medical screening should be completed before starting a resistance training program and exercise sessions should be monitored by an accredited exercise professional. All resistance training programs should be tailored for each patient.

## Further reading

Sarcopenia Day http://sarcopenia.com/?tag=sarcopenia-day
Australian Standard Adult Pre-Exercise Screening System: https://www.essa.org.au/for-gps/adult-pre-exercise-screening-system/
Nutrient Reference Values for Australia and New Zealand: https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/n35.pdf
American College of Sports Medicine Guidelines for Resistance Training in Older Adults: https://www.acsm.org/docs/brochures/resistance-training.pdf

## References

* 1 2 3 4 5 6 7 8 9 10 11 12 13 C, Anderson JL, Dalgas U, Berget J, Koskinen S, Aagaard P, Magnusson SP, Kjaer M. Resistance training induces qualitative changes in muscle morphology, muscle architecture and muscle function in elderly postoperative patients. Journal of Applied Physiology. 2008 April 17; 105: 180-86.
* 1 2 3 Cruz-Jentoft AJ, Landi F. Sarcopenia. Clinical Medicine. 2014; 14(2): 183-6.
* 1 2 3 Tyrovolas S, Koyanagi A, Olaya B, Ayuso-Mateos JL, Miret M, Chatterji S, Tobiasz-Adamczyk B, Koskinen S, Leonardi M, Haro JM. Factors associated with skeletal muscle mass, sarcopenia, and sarcopenic obesity in older adults: a multi-continent study. Journal of Cachexia, Sarcopenia and Muscle. 2016; 7: 312–321
* ↑ World Health Organisation (Internet). (Location Unknown): World Health Organisation. Active Ageing: A Policy Framework; 2002 (Cited 2016 Sept 02). Available from http://apps.who.int/iris/bitstream/10665/67215/1/WHO_NMH_NPH_02.8.pdf
* 1 2 Campbell WW. Synergistic Use of Higher-Protein Diets or Nutritional Supplements with Resistance Training to Counter Sarcopenia. Nutrition Reviews. 2007 Sept; 65(9): 416-422.
* ↑ Jadad AR, Enkin MW. Randomized Controlled Trials: Questions, Answers and Musings, 2nd Edition. USA: Blackwell Publishing; 2007
* ↑ American College of Sports Medicine. USA: ACSM; 2013. Resistance Training for Health and Fitness; 2013 (cited 2016 September 26); https://www.acsm.org/docs/brochures/resistance-training.pdf
* 1 2 Aagaard P, Suetta C, Caserotti P, Magnusson SP, Kjaer M. Role of the nervous system in sarcopenia and muscle atrophy with aging: strength training as a countermeasure. Scandinavian Journal of Medicine and Science in Sports. 2010; 20: 49-64.
* 1 2 Lang T, Streeper T, Cawton P, Baldwin K, Taaffe DR, Harris RB. Sarcopenia: etiology, clinical consequences, intervention and assessment. Osteoporosis International. 2010 September 10; 21: 543-559.