Presentation delivered at the Chartered Society of Physiotherapy National Conference 2019.

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