See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/301802827

Role of the physical therapy for sarcopenia Prevention and treatment of

sarcopenia in older people

Conference Paper · May 2015

CITATIONS READS

0 2,304

1 author:

Ирина Караганова
University of Ruse Angel Kanchev
16 PUBLICATIONS   0 CITATIONS   

SEE PROFILE

All content following this page was uploaded by Ирина Караганова on 03 May 2016.

The user has requested enhancement of the downloaded file.

 The 3rd International Virtual Conference on Advanced Scientific Results
May, 25. - 29. 2015, www.scieconf.com

Role of the physical therapy for sarcopenia

Prevention and treatment of sarcopenia in older people

Irina Karaganova
Faculty of Public Health and Health Care, Department of Public Health and Social Activities
University of Ruse „Angel Kanchev―
Ruse, Bulgaria

Abstract- Sarcopenia is the age-associated loss of skeletal muscle People who are physically inactive can lose as much as 3%
mass and function. It is a serious clinical problem threatening to 5% of their muscle mass per decade after age 30 [27].
independence and quality of life of older peoples.
The generic term for the loss of skeletal muscle mass,
There is convincing evidence that the presence of sarcopenia in quality, and strength that can lead to frailty in the elderly is
older patients may lead to significant decrease in the physical called sarcopenia [1, 23].
functioning, strength and health status. This leads to severe
It is estimated that sarcopenia affects 30% of people over
effects on quality of life in elderly people since sarcopenia is the
most frequent cause of impaired mobility, disability and
the age of 60 and more than 50% of people over the age of 80
increased risk of falls or mortality. [7].
This is a major clinical problem for the older people and the
All this determined the need to have a clearer picture of ongoing geriatrics and gerontology researchers [10].
interventions to prevent and tackle of the frailty in old age.
Geriatric rehabilitation has typically focused on patients
For this reason, in the last years there is a significant increase in with orthopedic issues such as hip fracture, joint replacement,
research interest in the field of the pathogenesis, treatment, arterial hypertension, diabetes mellitus and cerebrovascular
clinical consequences and the socioeconomic burden of this accidents. Little is known about the prevention and treatment
condition. The reduction of age-related frailty, disability and of the sarcopenia in older people [20].
suffering is a major priority of the health and social systems. The
general belief is that the physical activity can slow the loss of Sarcopenia is derived from the Greek word ―sarx‖ for flesh
skeletal muscle mass and function. The physical inactivity or a and ―penia‖ for loss (M.S. John Pathy 2006). This condition is
decreased physical activity level is a part of the underlying characterized by progressive atrophy of the skeletal muscles
mechanisms of sarcopenia. Therefore physical activity can be leading to adverse outcomes such as physical disability, poor
seen as an important factor to reverse or modify the development quality of life and disability [10].
of this condition.
Age-related loss of muscle mass and strength not only
In this report are presented different etiological factors and deprives elderly people of the ability to perform the most basic
prevention and treatment strategies against sarcopenia. One of activities of daily living, but also vastly heightens the risk of
the main strategies is the strength training which, together with suffering severe injuries, traumas and even death from sudden
other means of physical therapy plays a primordial role in falls and other accidents [10].
prevention and delaying progression of sarcopenia. The
resistance exercise offset the loss in muscle mass and strength The muscle weakness reduces general activity levels in
associated with aging, thereby improving functional capacity. elderly individuals which in turn elevates the risk of
osteoporosis due to a decrease in overall mechanical loading of
The current recommendations for physical exercise are that is the skeleton. At the same time, the sarcopenia is linked to an
should be individualized and adapted according the personal increase in the risk of metabolic disorders such as diabetes type
preference, comorbidities and other sensory limitations of the II [6].
adults.
It is widely accepted, that increased mechanical loading of
Resistance exercises are to be performed on two or more non- the musculoskeletal system (e.g., resistive exercise) can have a
consecutive days per week, using a set of 8 – 10 exercises for the beneficial effect on the thropics of skeletal muscle and the
whole body and at a moderate to vigorous level of intensity. supporting function resulting in a significant reduction in the
risk of developing all of the above age-related problems [6].
Keywords- Sarcopenia, Prevention, Physical therapy, Physical
The reasons why muscle mass and strength decline with
exercise
age are not fully understood. It is assumed that sarcopenia
I. INTRODUCTION arises from a variety of overlapping changes, which include
insulin resistance, changing endocrine function, chronic
It is well established that the aging process is associated diseases, inflammation, nutritional deficiencies and low levels
with numerous changes in the human body. One of the most of physical activity [10].
significant age-related changes is associated with progressive
reduction in muscle mass, muscle strength and function [18].

Medical and Health Sciences - Health sciences eISSN: 1339-9071, cdISSN: 1339-3561
- 281 - ISBN: 978-80-554-1059-3
 The 3rd International Virtual Conference on Advanced Scientific Results
May, 25. - 29. 2015, www.scieconf.com

PHYSICAL FUNCTION SARCOPENIA FRAILTY

IMPAIRMENT
- Weight loss;
- Muscle weakness; - Skeletal muscle loss; - Fatigue and a feeling of
- Difficulty in walking; - Poor quality of muscle tissue. exhaustion;
- Poor balance; - Cognitive disorders;
- Low physical activity. - Sedentary lifestyle;
- Social isolation.

Figure 1. The relationship between sarcopenia, frailty and impairment of physical function [5]

Therefore, the prevention and treatment of this syndrome Although there other treatment options such as
require an integrated approach that incorporates dietary pharmaceutical and nutritional supplements, the exercise
strategies, hormone replacement, nutritional supplementation, training is one of the most established treatment approaches for
and above all physical exercise. sarcopenia [14].
II. METHODS A primary factor in sarcopenia is disuse of skeletal muscle,
resulting in atrophy. The reduction in muscle strength is
The purpose of this paper is to present the importance of directly associated with loss of muscle mass. Inactivity may
the physical therapy and in particular of resistance training in also play a role, contributing to other factors affecting aging the
the prevention and treatment of sarcopenia in older people. muscles, including:
For the purpose of the present study were considered and  Neuromuscular realignment (changes in the motor
analyzed modern therapeutic approaches to prevention and units and innervation of the fibers);
treatment of sarcopenia.
 Reduction in the growth factors;
The analysis includes summaries of data of the several  Changes in muscle protein synthesis [16].
leading clinical studies examining the effects of physical
exercise on skeletal muscle in the aged. The loss of spinal alpha motor neurons associated with
aging probably there a major contributor to sarcopenia, since a
III. RESULTS reduction in neurological input is a well-established cause of
Although some age-related reduction physical functionality muscle atrophy [14].
is probably inevitable, there is a growing understanding that The established link between the inactivity and the losses of
changes in behaviours associated with aging, particularly the muscle mass and strength suggests that the physical activity
declines in physical activity, contribute to muscle weakness in should be a compulsory element of the prevention and
old age [20]. treatment of sarcopenia. The physical therapy program should
There is compelling evidence that the regular physical include resistance exercises, exercise to increase of muscle
activity is essential to maintaining and improving of the muscle strength, functional training, as well as endurance and aerobic
function, while avoiding adverse consequences of the training [24].
sarcopenia [14]. The strength training contribute not only to muscle
The physical therapy of sarcopenia is relevant because hypertrophy, but also leads to beneficial changes in
changes in muscle properties and performance can profoundly neuromuscular function [24].
affect an older person’s ability to walk, to self-service and to be It has been reported that, the resistance exercises to
independent. This is particularly serious problem for frail older positively influence the neuromuscular system, hormone
people who have low adaptation possibilities and physiological concentrations, and protein synthesis rate. Research has shown
reserve and are vulnerable to small changes in their physical that a program of progressive resistance training exercises can
status that can occur after an injury or illness [14]. increase protein synthesis rates in older adults in as little as two
weeks [27].

Medical and Health Sciences - Health sciences eISSN: 1339-9071, cdISSN: 1339-3561
- 282 - ISBN: 978-80-554-1059-3
 The 3rd International Virtual Conference on Advanced Scientific Results
May, 25. - 29. 2015, www.scieconf.com

To increases in muscle mass, strength and quality and also REFERENCES

a better neuromuscular adaptation, the exercise must contain
[1] Abate, M., A. Di Iorio, D. Di Renzo, R. Paganelli, R. Saggini, G. Abate.
resistance training including several exercises circuits with the Frailty in the elderly: the physical dimension. Eura Medicophys, 2007,
70 – 90% of the one repetition maximum, with an exercise 43 (3): 407 – 415.
predominantly eccentric and performed, at least, every two [2] Beas-Jimenez, J., D. G. Lopez-Lluch, I. Sanchez-Martinez et al.
non-consecutive days [2, 3, 13, 17, 21]. Sarcopenia, implications of physical exercise in its pathophysiology.
Prevention and treatment. Rev Andal Med Deporte, 2011, Volume 4
Research shows that, after a program of resistance training (4):158-166.
is introduced, motor neuron firing and protein synthesis (which [3] Boirie, Y. Phisiopathological mechanism of sarcopenia. J Nutr Health
are needed in building muscle mass) increase even in the Aging, 2009, Volume 13:717 – 723.
elderly [11, 22]. These changes indicate that it is possible to [4] Borst, S. E. Interventions for sarcopenia and muscle weakness in older
rebuild muscle strength even at an advanced age [11]. people. Age Ageing, 2004, 33:548–555.
[5] Cesari, M., F. Landi, B. Vellas et al. Sarcopenia and physical frailty: two
Aerobic exercise delays the strength loss and phenotypic sides of the same coin. Frontiers in Aging Neuroscience, 2014, Volume
changes produced during aging in muscle fibers, even at 6: 192 – 194.
moderated intensities [2, 13, 19]. This form of exercise has [6] Clarke, M. S. F. The effects of exercise on skeletal muscle in the aged. J
shown to aid in increasing protein synthesis, an important Musculoskel Neuron Interact 2004, Volume 4(2):175-178.
function in maintaining muscle mass and strength in the aging [7] Dorner, B., M. E. Posthauer. Nutrition’s Role in Sarcopenia Prevention.
population [25]. Aging Well, Volume 5 (3): 18.
[8] Frontera, W. R., V. A. Hughes, R. A. Fielding et al. Aging of skeletal
The other types of exercise interventions, involving gait, muscle: a 12-yr longitudinal study. J Appl Physiol., 2000, 88:1321–
balance, coordination and functional exercises, may also be 1326.
effective in reducing the risk and rate of falls as well as [9] Gillespie, L. D., M. C. Robertson, W. J. Gillespie et al. Interventions for
improving balance in older people [9, 12, 24]. preventing falls in older people living in the community. Cochrane
Database Syst Rev, 2012, 9:CD007146.
IV. CONCLUSIONS [10] Giovanni, I., G. Di Pietro, F. Gimigliano, G. L. Mauro et al. Physical
exercise and sarcopenia in older people: position paper of the Italian
The age-related loss of muscle strength and mass is a Society of Orthopaedics and Medicine (OrtoMed). Clinical Cases in
common problem that increases the risk of injury and Mineral and Bone Metabolism 2014, 11(3): 215-221.
disability in older people. Although most often seen in [11] Hasten, D. L. et al. Resistance Exercise Acutely Increases MHC and
physically inactive people, the sarcopenia is also common in Mixed Muscle Protein Synthesis Rates in 78 – 84 and 23 – 32 year olds.
American Journal of Physiology, 2000, 278:620-626.
those who remain physically active throughout their lives.
[12] Howe, T. E., L. Rochester, F. Neil, D. A. Skelton, C. Ballinger. Exercise
However, there is reliable evidence that an appropriate for improving balance in older people. Cochrane Database Syst Rev,
2011, 11:CD004963.
exercise program can improve strength in older people. The
[13] Jones, T., Stephenson KW, King JG, Knight KR, Marshall TL, Scott
physical activity, especially resistance exercise may slow and WB. Sarcopenia – mechanisms and treatments. J Geriat Phys Ther.
reverse age-related decrease in muscle strength as well as 2009;32:39-45.
improve physical mobility. [14] Latham, N. Phsiotherapy to treat sarcopenia in older adults. New
Zealand Journal of Physiotherapy, 2004, 32(1): 16-21.
The planned resistance training could be an effective [15] Lynch, G. S. Tackling Australia's future health problems: developing
countermeasure to prevent or reduce the adverse effects of the strategies to combat sarcopenia—age-related muscle wasting and
sarcopenia and improving the quality of life. Resistance weakness. Intern Med J., 2004, 34:294–296.
training enhances the strength, power and mobility function [16] Mazzeo, R. S. Exercise and the Older Adult., ACSM Current Coment,
and induces skeletal muscle hypertrophy. American College of Sports Medicine.
[17] Nelson, M. E., W. J. Rejeski, S. N. Blair et al. Physical activity and
Numerous studies have demonstrated convincing evidence public health in older adults: recommendation from the American
that resistance training can improve muscle strength and College of Sports Medicine and the American Heart Association.
Circulation, 2007, 116:1094-105.
improve the ability to perform tasks of daily living. Resistance
[18] Noran, N. H., A. Bulgiba, T. G. Hiong, I. Mudla. Sarcopenia in Older
training is the most effective exercise for slowing the rate of People. Geriatrics, Prof. Craig Atwood (Ed.), 2012, ISBN: 978-953-51-
loss of muscle mass and maintaining or improving muscle 0080-5.
strength [4, 8, 12, 15, 26]. [19] Park, H., S. Park, R. J. Shephard, Y. Aoyagi. Yeralong physical activity
and sarcopenia in older adults: the Nakanojo Study. Eur J Appl Physiol,
The physical activity should be personalized and adapted 2010, 109:953-61.
to subject's age and disability. The exercise program must be [20] Raj, G., J. Munir, L. Ball, D. B. Carr. An Inpatient Rehabilitation
carefully selected to minimize the risk of an injury, Service for Deconditioned Older Adults. Lippincott Williams &
particularly in the elderly, but also ensure enough strong effect Wilkins, Inc., 2007, Volume 23(2): 126–136.
to increase strength. The exercise interventions are carried out [21] Rolland Y, Czerwinski S, Abellan Van Kan G, Morley JE, Cesari M, et
al. Sarcopenia: its assessment, etiology, pathogenesis, consequences and
two to three times per week. Since all exercise effects are future perspectives. J Nutr Health Aging, 2008, Volume 12:433-50.
transient, the long-term exercise is very important [14, 27]. [22] Roth, S. M., R. E. Ferrel, B. F. Hurley. Strength Training for the
Prevention and Treatment of Sarcopenia. The Journal of Nutrition,
Health & Aging, 2000, Volume 4(3):143-155.
[23] Roubenoff, R. Physical activity, inflammation, and muscle loss. Nutr.
Rev., 2007, 65 (12 Pt 2): S208–12.

Medical and Health Sciences - Health sciences eISSN: 1339-9071, cdISSN: 1339-3561
- 283 - ISBN: 978-80-554-1059-3
 The 3rd International Virtual Conference on Advanced Scientific Results
May, 25. - 29. 2015, www.scieconf.com

[24] Sayer, A. A., S. M. Robinson, H. P. Patel et al. New horizons in the [25] Sheffield-Moore, M., C. W. Yeckel, E. Volpi et al. Post-exercise
pathogenesis, diagnosis and management of sarcopenia. Oxford metablolism in older and younger men following moderate aerobic
Journals, Medicine and Health, Age and Ageing, 2012, Volume 42 (2): exercise. Am J Physiol Endocrinol Metab, 2002, 287:E513-E522 4.
145-150. [26] Thomas, L. L. Resistance Training and Sarcopenia. Am J Lifestyle
Med., 2010, Volume 4 (4):317-319.
[27] Willian, B. Sarcopenia with aging. Web MD, Medical Reference, 2014.

Medical and Health Sciences - Health sciences eISSN: 1339-9071, cdISSN: 1339-3561
- 284 - ISBN: 978-80-554-1059-3

View publication stats