# Exercise as it relates to Disease/The effects of resistance training on Older Adults with Sarcopenia

This is an analysis of the journal article "Impact of resistance training on sarcopenia in nursing care facilities: A pilot study" by Hassan B.H, Hewitt J, Keogh J.W.L, Bermeo S, Duque G, & Henwood T.R. (2016).
Created by U3096886.

## What is the background of this research?

Sarcopenia is an age related health issue resulting in increasing loss of skeletal muscle mass, muscle strength and quality. This causes frailty, falls, fractures, disability and decreasing quality of life. Sarcopenia is commonly caused by malnutrition, increased sedentary behaviour and genetics of the individual. Current evidence shows preventing sarcopenia requires a nutritious diet and a long term exercise program reducing sedentary behaviour. Older adults who exercise have a reduced risk of sarcopenia, aerobic exercise is associated with enhanced effects on the cardiovascular system and metabolic health. Although beneficial, aerobic exercise doesn't promote muscle hypertrophy and cannot provide sufficient stimulus for an improvement in skeletal muscle mass. Resistance training however has greater benefits than aerobic training, due to the ability to restore and/or maintain skeletal muscle mass and improve neuromuscular efficiency through increased muscle stimulus and hypertrophy.
Apart from exercise, nutrition is also important, maintaining skeletal muscle mass. Protein is an important factor for older adults, having an increased recommended dietary intake for both males and females above the age of 70 from when they were in their 51–70 years of age.
The Australian RDI for protein:
* Male - 81g/day
* Female - 57g/day

## Where is the research from?

The research was from the University of Queensland with clearance from the Queensland Human Research Ethics Committee. The study was conducted from four aged care facilities in New South Wales and South East Queensland, which participated in a similar previous study.

## What kind of research was this?

This research study was a two group, randomised control trial with participants from four nursing homes undergoing a resistance training program lasting 6 months. The research period was 6 months to observe any adaptations from resistance training compared to no training, and see if these benefits can be maintained across a period.

## What did the research involve?

The 45 participants from the four facilities were requested to sign a consent form, in which they then underwent a baseline screening assessment. Three participants had pacemakers and were excluded, due to bio-electrical impedance analysis (BIA) contradictions. Those 42 participants had to then have medical clearance from each facilities medical practitioners. During the 6 month period one participant died before the follow up assessment.
The 20 participants in the exercise group underwent:.
* Six month period of resistance training
* Two 1x hour training sessions per week
* Use of air-pneumatic equipment (HUR Health and Fitness Equipment, Australia)
* Upper and lower body, and trunk exercises
* 2-3 sets per exercise with 10-15 repetitions.
* Exertion rate 12-14 Borg Scale
The 21 participants in the controlled group:.
* Continued their "usual care routine"

## What were the basic results?

The results indicate the 21 participants in each group exercised (Ex) and controlled (Con) had no significant difference at baseline testing (lean mass, skeletal muscle index, grip strength BMI etc).
Sarcopenia results
Results showed at baseline, 81% of the cohort had low muscle strength, 88.1% had low physical performance, 35.7% had low muscle mass and 35.7% had sarcopenia. Upon following up, the Ex group increased their muscle mass and muscle strength, decreasing the chances of sarcopenia however the number of sarcopenia individuals remained the same. The Con group increased in individuals with sarcopenia from nine to eleven. The entire Con group now had low physical performance, 95% had low muscle strength and 52% had low muscle mass.
Body composition results
The Ex group benefited from the six month program compared to the Con group. The exercise group upon follow-up noticeably improved in grip strength(kg) 21.0 (±7.0) and reduced body fat(%) from baseline 28.5 (±4.9) to 27.4 (±4.5). The important findings were that the ex group maintain lean mass(kg) from baseline 44.7 (±10.1) to follow-up 44.9 (±9.9) and skeletal muscle index (kg/m^2) baseline and follow-up 7.7 (±2.1).
The Con group decreased in grip strength(kg) 15.9 (±7.9), skeletal muscle index(kg/m^2) 7.7 (±72.1), lean mass(kg) 43.8 (±12.8) and gait speed(m/s)0.43 (±0.21).
How did the researchers interpret the results
Researchers determined resistance training is beneficial in reducing sarcopenia via increasing muscle strength, reducing the body fat % and preserve lean mass and skeletal muscle mass. Training must be maintained for the individuals to continue these benefits and prevent the onset of sarcopenia. Researchers interpreted the Con group had negative body composition effects across all areas increasing the risk of sarcopenia.

## What conclusions can we take from this research?

The research was undertaken in later years of life, beyond the average life expectancy for both genders, increasing the risk of sarcopenia due to being age related. However it's common for older adults to increase their skeletal muscle mass, muscle strength and quality with a resistance exercise program which must be repeated and maintained. We can take away that increased sedentary behaviour increases the risk of sarcopenia, decreasing muscle mass and is linked to an incline in muscle inactivity and movement. Nutrition is vital for older adults as nutritional requirements change with age and malnutrition is highly common. Protein requirements are greater in order to maintain and prevent muscle mass loss.

## Practical advice

Upon taking practical advice for resistance training and beginning a program, older adults should undergo pre-exercise screening and get medical clearance from their doctor. If individuals are cleared, resistance training is safe to undergo, and individual specific programs should be written including weight, exercises, sets and repetitions. This allows the individual to exercise in a safe environment with the knowledge for performance.

## Further information/resources

Further information on sarcopenia and prevention links below:
* Fitness Australia: http://fitness.org.au/articles/exercise-research-reviews/muscle-wasting-an-update-of-the-latest-evidence/8/641/1
* Nutrition Australia - Nutrition and older adults:http://www.nutritionaustralia.org/national/resource/nutrition-and-older-adults
* Nutrition Australia - Physical Activity for older adults:http://www.nutritionaustralia.org/national/resource/physical-activity-older-adults

## References

* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Hassan, B. H., Hewitt, J., Keogh, J. W. L., Bermeo, S., Duque, G., & Henwood, T. R. (2016). Impact of resistance training on sarcopenia in nursing care facilities: A pilot study. Geriatric Nursing, 37(2), 116-121.
* 1 2 3 Morley, J. E. (2011). Sarcopenia in the elderly. Family Practice, 29(1), 44-48.
* 1 2 3 4 Visvanathan, R., & Chapman, I. (2010). Preventing sarcopenia in older people. Maturitas, 66(4), 383-388.
* 1 2 Trappe, T. A., Konopka, A. R., Carroll, C. C., Dickinson, J. M., Trappe, S. W., & Harber, M. P. (2011). Aerobic vs. resistance exercise for combating sarcopenia in older individuals: A case study: 978. Medicine & Science in Sports & Exercise, 43(Suppl 1), 145
* ↑ Scanlon, T. C., Fragala, M. S., Stout, J. R., Emerson, N. S., Beyer, K. S., Oliveira, L. P., & Hoffman, J. R. (2014). Muscle architecture and strength: Adaptations to short‐term resistance training in older adults. Muscle & Nerve, 49(4), 584-592.
* 1 2 Nutrient Reference Values for Australia and New Zealand. National Health and Medical Research Council. [Online] Cited: 29/8/2016. Available from:https://www.nrv.gov.au/nutrients/protein
* ↑ Porter, M. M., Nelson, M. E., Fiatarone Singh, M. A., Layne, J. E., Morganti, C. M., Trice, I., Evans, W. J. (2002). Effects of long-term resistance training and detraining on strength and physical activity in older women. Journal of Aging and Physical Activity, 10(3), 260-270
* ↑ Seco, J., Abecia, L. C., Echevarría, E., Barbero, I., Torres-Unda, J., Rodriguez, V., & Calvo, J. I. (2013). A long-term physical activity training program increases strength and flexibility, and improves balance in older adults. Rehabilitation Nursing, 38(1), 37-47
* ↑ Australian Bureau of Statistics. Deaths, Australia, 2014. [Online] Cited 31/8/2016. Available from: http://www.abs.gov.au/AUSSTATS/abs@.nsf/mf/3302.0
* ↑ Gianoudis, J., Bailey, C. A., & Daly, R. M. (2015;2014;). Associations between sedentary behaviour and body composition, muscle function and sarcopenia in community-dwelling older adults. Osteoporosis International, 26(2), 571-579.
* ↑ Goldspink, G. (2012) Age-Related Loss of Muscle Mass and Strength. Journal of Aging Research.
* ↑ Yanai, H. (2015). Nutrition for sarcopenia. Journal of Clinical Medicine Research, 7(12), 926-931.