This document discusses age-related changes in the neuromuscular system and sarcopenia. It notes that with aging there is a progressive loss of muscle strength, mass and function which can increase fall risk, reduce mobility and independence. This effect is magnified by physical inactivity and is more prevalent with long-term health conditions. The document then defines and categorizes sarcopenia and discusses ways to assess muscle mass, strength and physical performance. It outlines the causes of sarcopenia and the benefits of strength training for older adults and those with long-term conditions.

1. Age-Related changes in
Neuromuscular system
Dr Tom Maden-Wilkinson
@TMadenWilkinson#StrengthSavesLives

2. AGEING POPULATION IN THE UK
+72.9%2066
2016
Number of people aged 65+
• Progressive loss of muscle strength, mass and function
• Fall risk, reduced mobility, loss of independence
• Effects magnified by physical inactivity.
• Prevalence greater in Long-term conditions
• Increased Healthcare Costs
@TMadenWilkinson
Janssen et al., 2002; Cruz-Jentoft et al., 2014; Pinedo-Villanueva et al., 2018; Larsson et al., 2018
Muscle Weakness costs the NHS £2.5 billion annually
What is
Sarcopaenia?

3. @TMadenWilkinson
Primary Sarcopaenia- Age-Related Muscle Loss- No Specific Cause
Secondary Sarcopaenia- Specific cause secondary to Long term condition
Sarcopaenic Obesity- Reduced Lean Body Mass + Excess Fat Mass
Cachexia - Muscle wasting accompanying diseases such as cancer, congestive
cardiomyopathy & renal disease associated with high inflammation.
Categorising
Sarcopaenia
Physical
Performance
Muscle
mass
Muscle
Strength
MusclePower

4. @TMadenWilkinson
40-45y
Population level focus should be to maximise our individual strength bank
account

5. Strength
Assessment
Muscle Mass
Assessment
Functional
Assessment
Grip
Strength
5 Sit to
Stands
DXA BIA Gait
Speed
Timed Up
And Go
SPPB
400m
Walk
M < 27kg
F < 16kg
> 15
seconds
M < 20kg
Muscle Mass
F < 15kg
Muscle mass
<0.8 m/s
Score < 8
>20s
> 6 mins
Malmstrom et al., J Cachexia Sarcopenia Muscle, 2017
Cruz- Jentoft et al., Age and Ageing, 2018.
@TMadenWilkinson
SARC-F
Questionnaire
Probable Sarcopaenia Confirmed Sarcopaenia
Severity
Screening for Sarcopaenia

6. @TMadenWilkinson
Loss of Muscle Mass
Impaired
Anabolism
Higher %
Type I fibres
Decreased
conduction
velocity
Systemic
Inflammation
Oxidative
Stress
Excitation-
Contraction
Uncoupling
Increase in Fat
Infiltration
Decrease in Anabolic
Hormones
(IGF-1,GH,Oestrogen,
Testosterone)
Endothelial
Dysfunction
Decrease
Tendon
Stiffness
Loss of Muscle
Strength and Power
Loss of
Motor
Neurons
Decreased
Voluntary
Activation
75
85
95
105
115
1 2 3 4
5-yrfollow-uprelaveto
baseline(%)
MVC
Torque
p=0.001
*
Quads
Volume
p=0.011
*
Voluntary
Ac va on
p=0.006
*
Specific
Force
p=0.161
12% 6% 4%
Trappe et al., J Appl Physiol 2001
McPhee et al.., J Gerontol A Biol Med Sci, 2018.

7.  Exercise and physical activity in older patients, produces at least the
same beneficial effects as those observed in younger individuals
 Exercise remains beneficial even in the oldest-old (Harridge et al.,
1999)
 To get the most effective programme we need to:
“Target specific adaptations through
increased loading and progression of
exercises that is appropriately
modified for the clients/patient level
of ability.”
@TMadenWilkinson

8. @TMadenWilkinson
8 months
5 sets x 5reps >85% 1RM
2 x per week
N=101 Postmenopausal Women
All T Score <-1.0
Deadlift, Overhead Press, Back Squat
• Increased Leg Extension and back
Strength
• Improved functional performance (TUG,
5STS)
• Improved Muscle Power (Vertical Jump)
Examples of Strength Training in LTC
Osteopenia/Osteoporosis

9. @TMadenWilkinson
The importance of Strength Training in LTC
• Improvements in Mass, Strength and Functional Performance
• Reductions in body fat and IMAT (T2D) (Pesta et al., 2017)
• Reduced Systemic Inflammation (COPD, Osteoarthritis)
• Increase in Glucose Tolerance (T2D) (Pesta et al., 2017)
• Reduced Pain (Osteoarthritis) (Latham and Liu, 2005; Husted et al., 2018).
• Reduced oxidative stress (T2D, COPD) (Pesta et al., 2017)
• Quicker recovery post-surgery (Husted et al., 2018; Stephenson et al., 2018)
• Less complications ”Better in, Better out” (Hoogeboom et al., 2014)
• Lower Therapy Fatigue (Cancer) (De Backer et al., 2007)

10. Strength Training recommendations
• Perform movements that are specific to ADL’s.
• Focus on multi-joint movements- Machine weights for beginners
• Work up to 3 sets per exercise- 2 minutes rest.
• Progress or Regress movements according your patient/client
ability.
• Overload- Work towards High Intensity (>80% maximum- Reps 8-12)
• Overload-Functional Tasks- Weighted Vests, Dumbbells etc
• Total body routine 2-3x per week.
@TMadenWilkinson
Law et al., 2017 Annu Rev Gerontol Geriatr

11. Exercise considerations in Sarcopenia
• Muscle strengthening activities and/or balance training may need to
commence prior to aerobic training in very frail adults.
• Chair and/or bed exercises may be considered as a starting point in very
frail adults.
• Consider limitations or contraindications to Exercise.
• Adopt a multi-disciplinary approach- Physio, OT, Exercise Scientists,
Nutrition
• Avoid bed rest wherever possible.
• Maximise Muscle Strength and Mass prior to Surgery.
@TMadenWilkinson

12. Thank you
@TMadenWilkinson
#Strengthsaveslives