Sport and Fitness Journal

Volume 11, No.3, Sept 2023: 236-241

E-ISSN: 2654-9182

EFFECT OF RESISTANCE EXERCISE TO PREVENT AND MANAGE SARCOPENIA

Dicky Hartono1*, Angela Christine1, Eny Anggraini1, I Putu Gede Adiatmika2

  • 1    Anti-aging Medicine Program, Faculty of Medicine, Universitas Udayana, 80234, Denpasar, Indonesia

  • 2    Physiology Department, Faculty of Medicine, Universitas Udayana, 80234, Denpasar, Indonesia Email : [email protected]

ABSTRACT

Demographic shift worldwide impacts skeletal muscle strength, with 80% of older people in low- and middle-income countries by 2050. Senotherapeutic interventions can counteract age-related changes. Sarcopenia is a loss of muscle mass and function because of the aging process. The goal of this literature review was to evaluate an resistance training efficacy on pre-sarcopenic body composition and strength in elderly. This literature review will investigate the effect of resistance training determined by body mass analysis in the sarcopenia patient. Google Scholar, ResearchGate, and Mendeley were used as the search engine. The keywords were strength training, resistance exercise & sarcopenia. The effect of resistance exercise on sarcopenia prevention were analyzed from 28.300 articles. Significant effect on sarcopenia proofed by body composition improvement. The depletion of lean body and total fat mass was analyzed by a mean of gram unit. An easy-to-use functional resistance exercise was effective to maintain functional strength and to gain muscle mass in pre-sarcopenia elderly patients.

Keywords : resistance exercise; weight training; sarcopenia

INTRODUCTION

The world's population is experiencing a demographic shift, with 80% of older people living in low- and middle-income countries by 2050. The proportion of the world's population over 60 years is nearly doubled between 2015 and 2050, from 12% to 22%. This growth in older population is expected to impact social systems and health systems worldwide. By 2030, 1 in 6 people worldwide will be aged 60 years or over, and by 2050, the world's population of people aged 60 and older will double, included the disease problem like sarcopenia.1 Senescence is a cell fate that contributes to aging-related pathologies in skeletal muscle (SkM). Studies on old mice reveal that a subpopulation expresses p16Ink4a and senescence-related genes, causing DNA damage and chromatin reorganization. A senotherapeutic intervention countered age-related changes and improved SkM strength. The senescence phenotype is conserved in older humans, providing evidence for cellular senescence as a potential mediator of SkM aging.2 The definition of sarcopenia is about muscle atrophy. This disease happens on a half of adult aged more than 80 years. Sarcopenia staging was explained by The European Working Group on Sarcopenia in Older People (EWGSOP). Pre-sarcopenia was low muscle mass condition. The low muscle mass and strength can be followed by poor physical performance.3 Falls will happen followed by fractures, overall poor health, or mortality. These changes could worsen the quality of life in elderly.4 Sarcopenia affects elderly patients with chronic heart failure, affecting muscle mass, strength, and physical performance. Techniques like resistance exercise and nutritional supplementation are commonly used to combat wasting disorders, but no universal gold standard exists.5 Sarcopenia prevention is important. Inactive body in elderly can make muscle wasting and malfunction.6 To prevent sarcopenia, physical activity should be increased.7 Sarcopenia and dynapenia, caused by muscle wasting, are significant concerns in old age. Resistance exercise training is suggested as a treatment, improving muscle strength and functional capacity in older adults. However, many prescribed programs are not best practices.8 This paper will investigate the effect of resistance exercise on sarcopenia.

METHODS

Google Scholar, ResearchGate, PubMed and Mendeley were used as search engines for this literature review. The literature review method uses journals and preliminary research publications.

Resistance exercise or weight training efficacy on sarcopenia are explored. The keywords were resistance exercise or weight training and sarcopenia. The literature search yielded 28.300 articles. There were 20 trusted articles with inclusion criteria of literature publication years 2012-2022. Indonesian or English was used. Non-full-text literature is excluded.

RESULTS

Eleven articles told the effect of resistance exercise on sarcopenia. Resistance exercise was programmed for 8 to 24 weeks. The number of participants varied between 36 and 235 subjects and the age group was approximately 65 years.

Table 1. The Analysis of Resistance Training Effect to Change Muscle and Body Mass in Sarcopenic Elderly

No

Article

Goal

Age

Population

Study Length

Intervention

Results

Drug treatment-induced

high

muscle mass,

1

hypertrophy for functional

To review the benefits

70 years old

70 patients

12 weeks

intensity resistance

strength, and function

training

improvement

improvemen t.9

increase in

fall

To identify

64-94 years

63 elderlies

before and

grip strength, functional

2

the efficacy

(17 males

10-

after

activities,

prevention.1 0

of preventive

old

and 56 females)

weeks

exercise program

LDH and

CKM with

measures

decrease in TnT

Comparison

Low & high-

with blood

to study the

met the inclusion criteria for this review

load blood

different

3

flow

BFR

People >50

2014-

flow

effect on

restriction

training

years old

2020

restriction

muscle mass

(BFR) training.11

efficacy

(LL & HL-BFR)

& strength

Fat infiltration

To assess the effects

two weekly

Good effect

and muscle

on clinical

65 min

for muscle

4

hydration improve

and

Mean: 79.8

38 women

six months

sessions for six months,

mass, muscle

after high-

magnetic resonance

years old

of

with a

mass index, fat mass and

intensity resistance training (HIRT).12

imaging (MRI) parameters

minimum recovery time of 72 h.

all strength variables

Effect of

To evaluate the effects

3 training

effectively control

Resistance

sessions in

Exercise on

on

79.3+5.1

2 months

non-

depressive

5

Depression

depression, muscle

years;

40 women

consecutive

symptoms, increased

in Mild

mass, and

66-85years

days every

isometric

Alzheimer

week for 12

Disease.13

muscle

weeks.

muscle

function

strength

increased to assess the                                                            muscle

efficacy on                                                                 strength,

Resistance

6

clinical                                                                     halted age-

ra n ng o     parameters                                                          related

peripheral                                                              high-

of             aged 70                                                 respiratory

muscles                                                     six        intensity

respiratory    years and     Fifty-one                                 function

benefits                                                     months   resistance

function and  older         women                                 decline,

respiratory                                                         (HIRT)

health-                                                                      benefit for

parameters.1 4               related                                                                      health

quality of                                                           related QoL

life (QoL)                                                              and physical

well-being.

Exercise

Effects of to                                              programmes

exercise on                                                                            Physical

summarize                                         with

muscle                                                                        performance

and                                                        isokinetic,

mass,                                                                         and muscle

7

synthesize                                              isometric,

strength,                       adults older                                                strength

w          tnP PV1Γ∣PT1PP                                                  ħ λ∕∩1YlPtt1C           w

t e ev ence                                  -         p yo metr c

and physical                 than 60       235 patients                             improvement

on muscle                              weeks    components

performance                 years                                                 , but

mass,                                                   require

according to                                                                           inconsistent

strength and                                            additional

the                                                                                    effect on

physical                                             equipment

EWGSOP                                                            musc e mass.

performance                                          for optimal

criteria.15

results.

adults

comorbid                              60 men

8

with                                    (34.5+13.7              an amino

to assess the                                               acid jelly

congenital                                 (18–68)                                 higher

nutritional                                              every day for

heart                         172 adults    years) and     2                         calorie,

status and                                               2 months.

disease:                    with CHD    112 women   months                 protein, and

nutritional     dietary                       (36.0+12.0                & resistance   fat intake

status,         intake,                         (19–70)                    training,

patients

dietary                                        years)

intake.16

physical      improved

9

Regulation    to delineate                                             exercise       muscle

of            the effects                        papers                could affect    performance

16 pre-       in English     were

mitochondri   of physical                                           mitochondria  via

clinical        with full text   pre-

al dynamic    exercise on                                             l quality       regulating

studies        and without    clinical

equilibrium.   mitochondri                                          control to      mitochondria

duplication    papers.

17             a in order                                               attenuate       l dynamic

sarcopenia     equilibrium,

the Timed-

Progressive                                                         Up-and-Go-

rogress ve                   779 articles   14                          p an   o

machine-                                                                  test, gait

to analyze    were        randomized                           enhanced

ase          the effects     scanned      controlled     2000      spee es ,     muscle

10

resistance                                                              Short

that long-     (PubMed,     trials were     and                       strength and

training for   term          Web of      included      2020     Physical       physical

prevention                                                          Performance

progression   Science,      within the                               performance

and                                                                Battery and 6

CINAHL)   review.

treatment.18                                                            min-walk

test

Effects of     to examine

Resistance    the effects    op o a       in men and                              maintaining

11

Training on   on                        women aged                           functional

supplement                   a 10-      instructor-led

Functional    functional                    70 years                                  strength and

Strength and  strength and  a on (n      with pre-      wee      program       increasing

Muscle       body            ) or o a    sarcopenia.                             muscle mass

Mass 19       composition  control

group (n = 34)

DISCUSSION

Drug treatment-induced muscle hypertrophy improved the functional elderly people musculoskeletal organ system. In their 70s elderly adult with sarcopenia used 12 weeks of high-intensity resistance training. Resistance training and physical activity can make muscle mass, strength, and function improvement.9

Sarcopenia, exercise and fall in the elderly were identified from the efficacy of preventive measures. Patient with ages between 64 and 94 were recruited. Totally sixty-three elderly individuals (17 males and 56 females) joined a 10-week program designed to improve balance, strength/resistance, flexibility and endurance. Grip strength improvement showed at right hand, from 21.4 to 22.3 kg. Overall functional performance were improved and followed by LDH and CKM increment (from 77.1 to 83.1 mU/mL, and from 106.9 to 114.0 μg/mL). TnT decreased from 16,2 pg/mL. The LDH and CKM slight increases as two key muscle enzymes indicate higher skeletal muscle utilization. The TnT serum levels decrement suggests a skeletal muscle strengthening.10

Blood flow restriction training was compared with conventional resistance training for the sarcopenia improvement in older adults using a systematic review and meta-analysis. A total of 14 studies included from PubMed, Web of Science, Embase, and Science Direct. Low-load blood flow restriction (LL-BFR) efficacy wasn’t significant on muscle mass compared with high-load resistance training (HL-RT). LL-BFR had a significant effect on muscle strength compared with HL-RT.11

Fat infiltration and muscle hydration in women with sarcopenia improved after high-intensity resistance training. A randomized clinical trial assessed the effects of high-intensity resistance training (HIRT) on clinical and magnetic resonance imaging (MRI) parameters from thirty-eight women. They were 20 women in the HIRT group. Their mean age was 79.8 years old. They joined the program for six months. Two weekly 65 min session resistance training for six months was combined with a minimum recovery time of 72 h. Regarding MRI parameters, infiltrated microscopic fat and hydration (T2) decreased significantly after six months resistance exercise program. 12

Resistance exercise efficacy on depression, muscle mass, and function in sarcopenia patient with mild Alzheimer Disease (AD). The study in 40 women with mild AD and sarcopenia consisted of 79.3+5.1 years (66-85 years). They joined 2 months of 3 training sessions in non-consecutive days every week. The participant will do 10-minute general warm-up, a 40-minute elastic resistance exercise using Theraband, and a cool down routine. Resistance exercise increased isometric muscle strength and can relieve depressive symptoms in elderly patients with sarcopenia.13

The efficacy of high-intensity resistance training (HIRT) on clinical parameters of respiratory function and health-related quality of life (QoL) were assessed by a six months study. The research was targeted fifty-one sarcopenic community-dwelling women aged 70 years and older. Muscle strength incline and halted age-related respiratory function decline could benefit health-related QoL and physical well-being.14

Muscle mass, strength and physical performance in older adults with sarcopenia according to the EWGSOP criteria were evaluated by four RCTs and three non-randomized interventional studies. A total of 235 patients with sarcopenia adults older than 60 years with sarcopenia were recruited from 2018 until September 2020. Randomized controlled trials (RCTs) and non-randomized interventional studies examined and showed an effect of exercise on physical performance and muscle strength. However, an inconsistent effect showed on muscle mass parameter.15

The nutritional status and dietary intake were compared and evaluated after the sarcopenic patient joined resistance training and amino acid intake on 172 adults with CHD. They were 60 men (34.5+13.7 (18–68) years) and 112 women (36.0+12.0 (19–70) years) who intervened by the 2 months program. An amino acid jelly every day for 2 months and resistance training were given to the patients. A home exercise was programmed every other day for 2 months. Patients exercised with elastic bands for arm and leg exercises. Adults with CHD have more calorie, protein, and fat intake. Their skeletal muscle mass was less than the normal one. So, amino acid intake followed by resistance training could improve body fat percentage, skeletal muscle mass, and edema in adults with CHD.16

Physical exercise could affect mitochondrial quality control in sarcopenia cases. Muscle performance improvement was regulated by mitochondrial dynamic equilibrium. Exercise can be an alternative intervention for sarcopenia.17 For analyzing the Timed-Up-and-Go-test, gait speed test, Short Physical Performance Battery and 6 min-walk-test improvement after the machine-based progressive resistance training showed the potential to reverse sarcopenia in the oldest old. Enhancemnt on muscle strength and physical performance was the evidence.18 A 10-week instructor-led resistance training program on functional strength and body composition was effective in maintaining functional strength and increasing muscle mass in older adults with pre-sarcopenia.19 Future perspective or direction for resistance training efficacy on sarcopenia is the molecular to bedside investigation, especially for the periodization and regional body target for the patient.

CONCLUSION

The eccentric training has the biggest benefit to increase skeletal muscle mass. It is hoped that future anti-aging resistance training research will be conducted with a larger sample size, gender balance, and specific age-restriction criteria.

CONFLICT OF INTEREST

Nothing is considered as the conflict of interest.

ACKNOWLEDGEMENT

The author appreciates the guidance of Prof. Dr. dr. I Putu Gede Adiatmika, M.Kes. He was our supervisor for the Basic Sports Medicine course, Anti-Aging Medicine concentration of Biomedical Science Graduate Program, Medical Faculty, Udayana University– Bali – Indonesia.

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