How can strength training build healthier bodies as we age?

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Some people perform incredible feats of strength and endurance well into their retirement years. The great news is: You don’t have to bench press 300 pounds or run a marathon to show off the benefits of strength training.

NIA-supported researchers have been studying the effects of strength training for more than 40 years and have identified multiple ways it can benefit older adults, including maintaining muscle mass, improving mobility, and increasing the healthy years of life. Learn more below about these findings from NIA-supported researchers, along with their tips for maintaining strength or becoming stronger as we age.

Some people have a hard time gaining muscle no matter how much they lift, while others have a hard time losing weight even when focusing on aerobic activity. This variability from person to person is another area of current research both at NIA and the institutions it supports.

— Eric Shiroma, Sc.D., staff scientist, NIA

Muscle mass: Use it or lose it

Age-related mobility limitations are a fact of life for many older adults. Studies have shown that about 30% of adults over age 70 have trouble with walking, getting up out of a chair, or climbing stairs. In addition to making everyday tasks difficult, mobility limitations are also linked to higher rates of falls, chronic disease, nursing home admission, and mortality.

A big culprit for losing our physical abilities as we grow older is the age-related loss of muscle mass and strength, which is called sarcopenia. Typically, muscle mass and strength increase steadily from birth and reach their peak at around 30 to 35 years of age. After that, muscle power and performance decline slowly and linearly at first, and then faster after age 65 for women and 70 for men. Those findings come from NIA’s Baltimore Longitudinal Study of Aging (BLSA) — the longest-running study of human aging — which pioneered a series of simple tests decades ago, known as the Short Physical Performance Battery (SPPB), to track mobility and muscle performance. The SPPB measures an individual’s balance, walking speed, and ability to get out of a chair five times, and then rates that person on a scale of zero to four.

However, such average decline of strength and power with aging can be substantially slowed down by maintaining an active lifestyle. While there is no way to fully “stop the clock,” it’s possible for many older adults to increase muscle strength with exercise, which can help maintain mobility and independence into later life.

NIA scientist Eric Shiroma, Sc.D., has studied the science of exercise for years and is an advocate of activities that add an extra challenge in our daily routines, such as turning a walk into “rucking,” which means wearing a weighted vest or backpack while exercising. He notes that a big key to understanding the range of responses to exercise is knowing how and why our bodies change with age and, perhaps more importantly, how and why these changes can vary from person to person.

“As we get older, there are inevitable functional and biological limitations that can cap exercise endurance, maximum strength, and fitness,” said Shiroma. “Some of these limitations can be slowed down through an active lifestyle that includes strength training. However, it is difficult to study these limits in normal day-to-day life. Studies such as the BLSA are special because scientists can test these limits in the clinic. For example, to test strength and endurance, study participants may be asked to walk or run on a treadmill, or climb stairs, for as long as they can comfortably continue. There are also genetic and environmental components to how people respond to physical challenges and exercise.”

By studying people’s limits and variability, researchers aim to provide older adults with evidence-based advice on how regularly moving and challenging their muscles may help increase their years of optimal health.

The science of strength

NIA-supported scientist Roger A. Fielding, Ph.D., associate director of the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University outside Boston, is a strong proponent of continuing to push our muscles as we age. He leads multiple studies aimed at better understanding age-related changes in muscle structure and function and how adding resistance training can prevent frailty and improve mobility and independence.

Fielding’s research has looked at how different types of muscle training exercises benefited a community-based group of older adults with moderate mobility limitations. According to Fielding, to understand the importance of maintaining muscle mass, it’s important to comprehend what’s going on inside our bodies when we exercise our muscles.

Strength training (also known as resistance training) is different than aerobic exercises such as running, cycling, or walking. Weightlifting, either with machines or free weights, is one type of resistance training. Other types include using medicine balls or resistance bands, or body weight-bearing exercises such as pushups, squats, or yoga. Resistance training requires our muscles to contract to lift a heavy object against the pull of gravity.

The more weight we contract against, the faster our bodies burn through reserves of adenosine triphosphate (ATP), a molecule that carries energy to cells. As we lift weights or do other demanding exercises, our ATP reserves are replenished through a complex, coordinated metabolic and chemical response that cascades through the entire body, including sparking short-term chemical changes in the DNA of muscle tissue that make them more tuned to specific proteins supporting sugar and fat metabolism.

Fielding and his colleagues have found that the best recipe for improving physical function and avoiding disability is a combination of walking and resistance training. In the NIA-supported research, older adult volunteers participate in small group exercise sessions led by a physical fitness trainer. Several of these studies were conducted at Tufts, but the program has since expanded to nearby Boston-area gyms and community senior centers. The goal isn’t a perfectly chiseled abdomen or achieving exceptional feats of strength. Rather, participants use different types of ankle weights and dumbbells, or adapt exercises as needed to use their own body weight.

When you do resistance or strength training, very important chains of molecules that relay signals between cells are affected, and these changes linger in the body for hours after exercise, building up a cumulative, positive effect. Even a low-intensity strength and walking program has substantial benefits.

—Roger A. Fielding, Ph.D., associate director, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University

The group sessions also encourage bonding and accountability among participants, which helps keep them motivated and sticking with it, according to Fielding and his colleagues.

Fielding doesn’t just talk the talk, he’s an advocate of strength training himself.

“I’ve always run three or four times per week, but, about three years ago, I started making strength training part of my routine, and I feel stronger,” he said. “My goal is to be able to do things I enjoy, including downhill skiing, as long as I can, and the best way to do that is to try to stay active.”

Can strength training help prevent obesity as we age?

While strength training is great for otherwise healthy older adults, what about those who are overweight or living with obesity? NIA supported scientist Dennis T. Villareal, M.D., a professor at the Baylor College of Medicine in Houston, has found that incorporating weightlifting into an exercise and diet intervention for older adults with obesity yields better results than diet or aerobic exercise alone.

Villareal and his colleagues work with older adults with obesity, including volunteers from a nearby Veterans Affairs hospital and others recruited from the surrounding community. Their study participants are still functionally independent but are at risk of losing that ability.

“We work at the intersection of two big changes for society: aging and obesity,” Villareal said. “About one-third of older adults have obesity and that number is rapidly expanding.”

Villareal has been studying the nexus of muscle and metabolism for nearly 25 years. He got his start in the field in the 1990s at one of NIA’s Claude D. Pepper Older Americans Independence Centers. He helped with an exercise training study in frail adults over age 75 and was impressed with how it was possible for people to get motivated to exercise even at an advanced age. After losing about 20 pounds in recent years (thanks to a lower calorie diet combined with exercise), he himself experienced the benefits of weight loss, including more energy and improved physical fitness.

According to Villareal, it’s not well understood that older adults with obesity can also be frail, which creates a vicious cycle of mobility and independence loss as the years and pounds add up.

“Folks with obesity need more muscle mass to carry their body weight,” Villareal said. “When they get older, they can’t compensate by producing more muscle mass, so you get sarcopenic obesity, which is the worst of both worlds. ”

Villareal’s year-long exercise training intervention known as the Lifestyle Intervention to Improve Bone Quality (LIMB-Q) targets this high-risk population. As people lose weight with diet and aerobic exercise, they have an increased risk of losing lean muscle mass and bone density, both of which are important for everyday activities and avoiding falls.

“That’s where strength training has an important role,” said Villareal.

Villareal’s team found that a healthier diet combined with a workout mixing aerobic exercise, resistance training, and balance was most effective for helping reverse frailty in obese older adults.

“Resistance training is the most important component because it builds muscle and reduces the loss of muscle mass,” he said. “As the relationship between body mass and muscle becomes more positive, participants lose more fat than they lose muscle, so the relative sarcopenia is improved significantly. Combining the two types of exercise had additive effects so they were better together than separate. ”

One of the big rewards for Villareal and his team is observing participants who make positive changes and stick with them. Some volunteers have even exceeded the 10% body weight loss target, losing as much as 20% of their body weight. The weight losses combined with building muscle mean they feel better and become more independent and mobile.

Villareal notes that starting slow and attending regular group classes are important steps to building confidence and connections among participants.

The value and joy from group exercises is that participants motivate and encourage each other. Once the study is over, they are advised to continue to incorporate exercise into their regular routines. They often want to participate in other studies and become cheerleaders for the program.

—Dennis T. Villareal, M.D., professor, Baylor College of Medicine in Houston

In the future, Villareal hopes to explore the possibility of larger, longer-term studies to see if the intervention can prolong physical independence and delay the need for nursing home admission.

An innovative INVEST-ment

As if it wasn’t already tough enough to get and stay motivated to exercise, unanticipated factors such as the COVID-19 pandemic, severe weather events, etc., can prevent some older adults from going to the gym and exercising indoors with larger groups. To help overcome these types of barriers, a team of NIA-supported scientists from the Wake Forest University School of Medicine in Winston-Salem, North Carolina, is researching innovative ways to bring resistance training to the homes of older adults who are trying to lose weight. Investigators Barb Nicklas, Ph.D., professor, gerontology and geriatric medicine, and Kristen Beavers Ph.D., M.P.H., R.D., associate professor, Department of Health and Exercise Science, have developed a project known as Incorporating Nutrition, Vests, Education, and Strength Training in Bone Health (INVEST).

Kristen Beavers walking with an INVEST participant.
Image credit: ©Wake Forest University/Ken Bennett

In previous studies of how to prevent the bone loss that comes with weight loss, Beavers and Nicklas saw that resistance training helped participants lose weight and become more fit, but it was hard for people to stick with the training long term. While not a substitute for traditional strength training, the researchers are now studying if wearing a weighted vest throughout the day can help prevent the bone-density loss that often occurs with weight loss.

INVEST participants wear their weighted vests for eight hours a day in addition to undertaking a 12-month weight loss program. The vests, which can be worn under one’s clothes, are lined with small rectangular pockets that hold one-eighth-pound incremental weights. When a participant loses a given amount of body weight, that same amount is added back to their vest. The compounding effect is to keep the skeleton loaded as excess body weight is lost, avoiding harmful loss of bone density that can increase the risk of fractures.

A pilot INVEST study showed that volunteers who wore the weighted vest as they participated in the weight loss plan also slowed down hip bone-density loss compared to the weight-loss-plan-only group. This support for how different ways to load and challenge the skeleton could reduce the risk of hip fractures, a common and often debilitating injury for older adults.

“The vest is also a nice ‘show-and-tell’ motivational tool,” Beavers said. “They can show friends or family, ‘Look at how much weight I’ve lost!’”

Tips for staying strong in your daily routines

There’s no denying that our ability to respond to exercise gets blunted as we grow older. No individuals, even seemingly superhuman pro athletes who keep winning championships into their 40s, will have the same physical response to exercise at age 70 as they do at 30 or even 40. So, what is some bottom-line, realistic advice to keep strong and moving as we age?

Know what to expect. First, don’t try to compare yourself to younger people. Everyone is unique and we all age differently.

We all should think about how to build up a base of strong muscles to prepare for the loss of muscle and strength that we will experience as we age.

— Barb Nicklas, Ph.D., professor, gerontology and geriactric medicine, Wake Forest University School of Medicine

Nicklas notes, “A 60-year-old is very different from an 80-year-old. We need to be careful about lumping all older people into the same category. Aging starts at birth, and throughout our lifespans, exercising to help prevent disease and disability is very important. Movement, strength, and balance training is important at any age, but we need to adjust our expectations.”

Move mindfully. Beavers points out that low bone density and muscle strength are associated with increased falls and fractures. Exercises that incorporate mindfulness with balance and movement, such as tai chi and yoga, can improve strength in these areas and help prevent falls and fall-related fractures.

Make it part of your daily routine. Villareal emphasizes that if online or in-person group classes aren’t your thing, everyone can still work exercise into their daily routines.

“We encourage people to just walk more,” he said. “Walk around the house or office, walk to the store. In the office you can take brief exercise or stretching breaks every 15-20 minutes and try to use all your muscles. ”

Keep it fun. According to Fielding, “It’s about finding things that people want to do and like to do, not just exercise for exercise’s sake, but something we enjoy. Goal setting is also important. We ask our volunteers to list everyday things they want to be able to keep doing as they grow older, like play with their grandchildren or be able to take laundry up and down the stairs. Lots of things count as exercise: It doesn’t have to be running or going to the gym or riding a stationary bike. It could be dancing, gardening, or housework.”

He recommends NIA’s exercise and physical activity pages or the National Physical Activity Guidelines as good sources to help anyone get started.

Set realistic goals. Fielding noted that everyone is different and it’s not one size fits all.

“Some like group exercise, others prefer a solitary routine to clear their head,” he said. “But setting realistic goals is important. A good goal is about 150 minutes per week of moderate-level exercise, but you see benefits even at lower levels than that. Older adults should try to get strength training in the mix one to two times per week.”

The bottom line is to get moving.

“Any physical activity is better than no physical activity. Even a couple minutes per day matter, and small changes lead to big improvements.”

Older Adults and Balance Problems

Have you ever felt dizzy, lightheaded, or as if the room were spinning around you? These can be troublesome sensations. If the feeling happens often, it could be a sign of a balance problem.

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Many older adults experience problems with balance and dizziness. Problems can be caused by certain medications, balance disorders, or other medical conditions. Balance problems are one reason older people fall. Maintaining good balance as you age and learning about fall prevention can help you get around, stay independent, and carry out daily activities.

Causes of balance problems

Read and share this infographic and help spread the word about how to help prevent falls.

People are more likely to have problems with balance as they grow older. In some cases, you can help reduce your risk for certain balance problems, but problems often can start suddenly and without obvious cause.

Balance problems can be caused by certain medications or medical conditions. The list below covers some common causes of balance problems.

• Medications. Check with your doctor if you notice balance problems while taking certain medications. Ask if other medications can be used instead, if the dosage can be safely reduced, or if there are other ways to reduce unwanted side effects.
• Inner ear problems. A part of the inner ear called the labyrinth is responsible for balance. When the labyrinth becomes inflamed, a condition called labyrinthitis occurs, causing vertigo and imbalance. Certain ear diseases and infections can lead to labyrinthitis.
• Alcohol. Alcohol in the blood can also cause dizziness and balance problems by affecting how the inner ear works.
• Other medical conditions. Certain conditions, such as diabetes, heart disease, stroke, or problems with your vision, thyroid, nerves, or blood vessels can cause dizziness and other balance problems.

Visit the NIH National Institute on Deafness and Other Communication Disorders website for more information on specific balance disorders.

Symptoms of balance disorders

If you have a balance disorder, you might experience symptoms such as:

• Dizziness or vertigo (a spinning sensation)
• Falling or feeling as if you are going to fall
• Staggering when you try to walk
• Lightheadedness, faintness, or a floating sensation
• Blurred vision
• Confusion or disorientation

Other symptoms might include nausea and vomiting; diarrhea; changes in heart rate and blood pressure and feelings of fear, anxiety, or panic. Symptoms may come and go over short periods or last for a long time and can lead to fatigue and depression.

Treatments for balance problems and disorders

Exercises that involve moving the head and body in certain ways can help treat some balance disorders. Patient-specific exercises are developed by a physical therapist or other professional who understands balance and its relationship with other systems in the body.

Balance problems due to high blood pressure may be managed by eating less salt (sodium), maintaining a healthy weight, and exercising. Balance problems due to low blood pressure may be managed by drinking plenty of fluids such as water; avoiding alcohol; and being cautious regarding your body’s posture and movement, such as never standing up too quickly. Consult with your doctor about making any changes in your diet or activity level.

Coping with a balance disorder

Some people with a balance disorder may not be able to fully relieve their dizziness and will need to find ways to cope with it. A vestibular rehabilitation therapist can help develop an individualized treatment plan.

Chronic balance problems can affect all aspects of your life, including your relationships, work performance, and your ability to carry out daily activities. Support groups provide the opportunity to learn from other people with similar experiences and challenges.

If you have trouble with your balance, talk to your doctor about whether it’s safe to drive, and about ways to lower your risk of falling during daily activities, such as walking up or down stairs, using the bathroom, or exercising. To reduce your risk of injury from dizziness, do not walk in the dark. Avoid high heels and, instead, wear nonskid, rubber-soled, low-heeled shoes. Don’t walk on stairs or floors in socks or in shoes and slippers with smooth soles. If necessary, use a cane or walker. Make changes to add safety features at your home and workplace, such as adding handrails.

Learn more about falls and falls prevention.

Read about this topic in Spanish. Lea sobre este tema en español.

For more information on balance problems

MedlinePlus
National Library of Medicine      
www. medlineplus.gov

Mayo Clinic
www.mayoclinic.org/patient-care-and-health-information

National Institute on Deafness and Other Communication Disorders
800-241-1044
800-241-1055 (TTY)
[email protected]
www.nidcd.nih.gov

This content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date.

Content reviewed:
September 12, 2022

Related Articles

Falls in old age

Total duration: 29:02

00:00

Oksana Mikhailovna Drapkina, Executive Director of the Internet Session, Secretary of the Interdepartmental Council for Therapy of the Russian Academy of Medical Sciences:

– If you don’t mind, we’ll move on to the second lecture. It will focus on falls in the elderly and is titled “Falls in old age as the second most important cause of fractures. ”

Belaya Zhanna Evgenievna, Candidate of Medical Sciences, Senior Researcher of the Endocrinology Research Center:

– My lecture is devoted almost entirely to the problem of falling. According to the 2008 WHO definition, a fall is an unintentional transition to a position of rest on the ground, floor, or other lower level, excluding the purposeful change of position of the body to rest on furniture or other objects.

In the international classification of diseases, the fall ranks 19points, which is a lot, 11 of them are falls from the height of their own growth. No wonder the fall belongs to the class of external causes of morbidity and mortality. According to the same WHO report, 30-50% of people over 65 fall at least once a year. 10 – 15% of these falls result in serious injuries, 5% lead to hip fractures. However, these 10-15% are responsible for 5.3% of all hospital admissions and 90% of all hip fractures.

The cost of such falls is also very high. According to Finland and Australia, one fall costs $3,611. A big amount. It does not include the amount required for the rehabilitation of patients if the patient does not get up after a fall.

What risk factors can we identify that affect falling in old age? The World Health Organization identifies environmental risk factors that are certainly important for our country. This is an ill-conceived layout of the house and yard, slippery stairs, dilapidated railings, ice, slippery, wet floors, insufficient lighting.

Social risk factors. Low income, social isolation of the elderly, unavailability of medical care and preventive measures, unsuitable place of residence (unequipped apartments in a special way).

Physicians to a greater extent, probably, include biological factors. It’s age, gender. The older our patients are, the more often they fall. Women fall more often than men. But men are more likely to die from these falls. There are a number of diseases that, at any age, certainly increase the risk of falls, which we, as doctors, need to rule out.

02:38

Important behavioral risk factors that doctors also pay attention to. A report by American surgeons has published a poster summarizing all the potential risk factors to consider for an elderly patient in their own home.

Surgeons recommend that our women and older men have good lighting on the stairs and always use the railing. Shoes should be selected in a special way. It shouldn’t be slippery. Should not be on too thick soles, because with a thick sole, sensitivity is lost.

Furniture. When choosing furniture, we pay attention to small ottomans. Low furniture causes falls. Patients slip easily on the mat, especially small mats.

All aisles of an elderly person should be so wide that he does not have to walk sideways, because this increases the risk of falling sideways. The cleanliness of the room is of great importance. Toys or other items that lie independently in an elderly person’s room can cause tragedy. Particular attention in this situation is given to wires.

Only bright lamps should be used for illumination. Corners should be especially well lit. Light sources should generally be in close proximity to the patient so that the person does not have to grope at night.

Preparations. We ourselves prescribe a large number of antihypertensives, sedatives. In overdose, they cause falls. Ophthalmologists, cardiologists, having carried out surgical treatment of cataracts or the installation of pacemakers in time, significantly reduce the risk of falls in the elderly.

Particular attention is paid to the bathroom, which should be equipped with special non-slip rugs. It should be low so that it is convenient for an elderly person to climb. It is advisable to use a handrail.

Oksana Drapkina: Zhanna Evgenievna, I’m sorry, I’ll interrupt for a second, because we have a direct call from St. Petersburg. Colleagues really want answers. I don’t know who this question is for.

Question: The development of osteoporosis with inhaled glucocorticoids in adolescents who have not reached peak bone mass, are there any remote (inaudible, 05:20) in relation to the development of osteoporosis and the prevention of these conditions. This is the first question.
Second question. A 43-year-old woman came with the results of a densitometric study (premenopausal woman), we assess the presence or absence of osteoporosis by T-score. But the indicators turned out to be beyond the criterion of 3.2, and (inaudible, 05:47). Interpretation of the result.

05:51

Ershova Olga Borisovna, Professor, Vice-President of the Russian Osteoporosis Association:

– About a teenager who needs to take an inhaled glucocorticosteroid. It is now reliably known that any glucocorticosteroid in any form, regardless of dose, is a very significant risk factor. This should no doubt be taken into account when starting any systemic glucocorticosteroid intake, if it is planned for a long time.

Accordingly, in order to prevent the development of osteoporosis, this adolescent should receive prophylaxis from the first days. Basically, these are calcium and vitamin D preparations. It all depends on whether there are other risk factors. Then this prevention can be strengthened. Absolutely individual approach. It is important to know only one thing, that you absolutely need to think right now that this patient may get sick.

Rodionova Svetlana Semyonovna, professor, doctor of medical sciences, head of the Scientific Center of the Institute of Traumatology and Orthopedics:

– In general, our experience shows that the lack of understanding of doctors who prescribe glucocorticoids, saving the life of a child, they do a good deed, but in fact they miss the time for the treatment and prevention of osteoporosis. Here they are very sensitive to this particular effect, because glucocorticoids act on osteoblasts and inhibit the process of bone formation. We receive these patients with fractures, with complications. Although, it would seem, you prescribe glucocorticoids and immediately prescribe vitamins D.

Olga Ershova: It is impossible to do without them. This is all clear.

Svetlana Rodionova: Impossible, by no means. It saves a child’s life. But at the same time, give calcium supplements to the child, give vitamin D. A lot has been written and said about this.

Olga Ershova: Especially since these are standards.

Svetlana Rodionova: Unfortunately, we see how many clinics do not do this. Of course, it’s a pity. Chemotherapy for oncological children is very often carried out now. They should immediately be prescribed vitamin D preparations. Do not be afraid that there will be malignancy or the process will proceed more rapidly. No.

It has now been shown that even the treatment of some tumors is carried out with an active metabolite of vitamin D. For example, prostate cancer, some forms of breast cancer. This should become part of everyday practice. We are very active in this.

08:10

Olga Ershova: On the second question, on interpretation. There are ironclad rules for the interpretation of densitometric studies, which must be followed very well. For postmenopausal women, regardless of age, only the T-test is used. Everything about pre-menopausal women, regardless of age (and men under 50), is a Z-score. Accordingly, according to these criteria, it is interpreted whether there is osteoporosis or not.

Zhanna Belaya: Still, probably, in the interpretation of osteoporosis at the age of 43, not only the criterion itself is important to us, but also the presence or absence of fractures. If this woman did not have any low-traumatic fractures, then perhaps we can not pay so much attention to her densitometry. We know that any method has a certain sensitivity. The sensitivity of the method is low, it is 50%, that is, it misses 50% of patients.

The specificity is also not 100%, it is 95%. This means that there will always be those 5% who are actually healthy, but according to densitometry, they will turn out to be . ..

Olga Ershova: Significant figures were heard there. You can’t ignore them.

Zhanna Belaya: Unfortunately, there are no drugs of proven effectiveness in a woman of this age, if she is not a postmenopausal woman. I would certainly look for the reason here.

09:34

Olga Ershova: The reason must be looked at, first of all.

Zhanna Belaya: Cause of secondary osteoporosis. Exclude endocrine, rheumatic diseases.

Svetlana Rodionova: Yes, this should be done. Another thing is that it can be most often secondary. But maybe this is an idiopathic form that is possible in young women. The number of hip fractures in women with osteoporosis, able-bodied, giving birth and menstruating well, is increasing every year. This, too, cannot be ignored. Another thing is that the clinician should examine the patient well.

Olga Ershova: Idiopathic is still a diagnosis of exclusion. First, the cause must be found.

Svetlana Rodionova: With the primary one, you may not find the cause.

Zhanna Belaya: There is always the question of proven cures for this woman.

Oksana Drapkina: Dear colleagues from St. Petersburg, thank you for your interesting questions. We will be happy to answer your questions further. We will be happy to continue the presentation of Zhanna Evgenievna. Please.

Zhanna Belaya: We return to the room where the woman has lived, perhaps all her life. As physicians, we cannot limit ourselves to forbidding a woman or recommending that she do this or that. We must move on. Trying to figure out at the current level of knowledge what predetermines such a change in the quality of her life.

Why did she feel great in this room for 20 years, and, for example, at 60 she had to limit herself and adapt her bath. Or at 65. More often, of course, later.

11:12

So a whole list of troubles that people get with age is associated with somatopause, andropause, menopause, adrenopause and D-hormone deficiency, respectively, a decrease in vitamin D and a parade of hormones. At least several of these hormones affect muscle mass, that is, determine the ability of a person to varying degrees to resist a fall.

It has been proven that the D-hormone, its expression in muscle tissue …

It has long been known that for the normal development and response of muscle tissue to the load …

More recently, a study was conducted that included more than 6,000 people. Vitamin D receptor polymorphism increases the risk of fractures. Also, polymorphisms in the vitamin D receptor gene are associated with an increased risk of falls, decreased ability to maintain balance, and decreased muscle strength.

How do we keep balance. There are two main forms of balance. This is static balance, balance without changing the area of ​​​​support. This usually requires good calf muscle strength and good thigh muscle strength. Or maintaining balance with a change in the area of ​​\u200b\u200bsupport. As a rule, the change in the area of ​​support occurs very quickly and reflexively and is associated with a strong contraction of the muscles.

Normally, strong muscle contraction is provided by fibers of the second type. These are fast fibres. They are able to contract at high speed and with high force. They cannot contract with the same force for a long time, because this is an anaerobic exchange, but they are responsible for a good reaction to a fall, that is, a good balance.

With age, fibers of the second type begin to decrease in diameter and are gradually replaced by fibers of the first type. They are well adapted to aerobic exercise and provide monotonous walking or even monotonous running. But they are not able to develop a high contraction force at once. With age, the volume of muscle mass does not change, but the quality of the muscle fiber already changes.

13:43

Finally, due to various diseases or at a later age, we see the development of sarcopenia. Not only the replacement of fibers of the second type with fibers of the first type, but also the reduction of all forms of fibers (inaudible, 13:59), that is, motor neurons die. In fact, the muscles become incapable of contraction.

The problem of combating sarcopenia is no less complex and studied than the problem of combating osteoporosis, that is, bone loss. Muscle mass is also important for maintaining a person’s independence.

Much attention is paid to the somatopause, because for a long time it was believed that insulin-like growth factor is able to provide exactly good muscle mass. However, all the studies that were conducted on the introduction of growth hormone preparations to the elderly did not lead to a good result. Even the introduction of insulin-like growth factor directly also did not lead to a satisfactory result.

It has been proven that endogenous stimulation of the pituitary gland in the production of somatotropic hormone, in particular, physical activity, is effective. Exercises for balance, for the development of muscle mass at any age, allow you to slightly increase muscle mass.

Prescribing sex hormones is also effective, but we know that there are certain contraindications. If we are talking about the D-hormone (this is the third component of maintaining normal muscle mass), then, of course, physical activity will not help us here. D-hormone is synthesized from “Colecalciferol” – native vitamin D, which may not have any biological activity and can be synthesized in our body when exposed to ultraviolet radiation of a certain wavelength. We can also get it from food (fatty fish, butter, or fortified dairy products).

If the weather worsens, then calcium is one of the sources of vitamin D. With age, the nature of the clothes of patients changes. The very ability of the skin to synthesize vitamin D is also dramatically reduced. If a child synthesizes vitamin D well in the skin, then in an elderly person, due to the thinning of the dermis, this synthesis occurs much worse, and sometimes almost does not occur at all.

Thus, we observe a decrease in the level of “Colecalciferol”. It would seem that this native vitamin D should be supplemented. This can be quite effective if other enzymes work normally – enzymes that convert Colecalciferol into D-hormones, namely, 25-hydroxylase (liver enzyme). It, as a rule, is violated only with severe liver damage, cirrhosis. An important enzyme is 1?-hydroxylase. Its deficiency leads to a decrease in the level of D-hormone.

16:46

We can say that even a slight decrease in kidney function can lead to a decrease in the level of D-hormone. This is theoretical. Indeed, in older people, we see a progressive decline in kidney function. It does not lead to azotemia, but kidney function gradually decreases.

In practice, the study was also carried out. It has been shown that in patients with a slight decrease in glomerular filtration rate, which is in no way related to renal insufficiency, it is nevertheless observed. 65 ml/min. , 60 ml/min. We are already seeing deterioration in functional test execution.

The blue “curve” is a balance test. The lower the glomerular filtration rate, the lower the elderly patient can balance.

The yellow and green stripes are different tests. Chair rise tests test the strength and speed of contraction of the hip muscles (the muscles we need to maintain balance). Yellow is a dynamic balance test. The person must go at speed. The lower the glomerular filtration rate, the more time our patients need to perform these tests.

It has been directly shown that in patients with a glomerular filtration rate less than 65 ml/min. the risk of falls increases, and the risk of fractures increases.

1781 women and men with osteoporosis were tested. Indeed, those with reduced glomerular filtration rate have a higher risk of fracture, even if they did not differ in neural bone density. I want to draw your attention to the fact that these were those patients who obviously had a normal level of vitamin D.

18:32

There is another problem that older people face. Even with normal kidney function, a decrease in the expression of D-hormone receptors can be observed. It is observed with age.

On the left, the difference between biopsy muscles at 91 and 51 years old. On the right, the level of D-hormone expression in women of different ages from 21 to 91 years old. Naturally, these women got into some unpleasant situations, they needed surgical intervention. Accordingly, against the background of muscle biopsy, the level of D-hormone expression was monitored. The “curve” is perfectly clear. We observe a decrease in this expression.

To summarize, no matter how progressive and actively sunbathing our woman may be, the ability of the skin to synthesize vitamin D decreases. Thus, the level of “Colecalciferol” in the blood serum decreases. If we still have a decrease in the level of 1?-hydroxylase, then there is a decrease in the content of the level of D-hormone.

Further, the situation of using a more active form of vitamin D, in particular “Alfacalcidol” (“Alfacalcidol”), allows us to overcome this problem. The problem of reducing both the glomerular filtration rate and the problem of reducing the ability to synthesize vitamin D3 in the skin. We can replenish the level of D-hormone.

In addition, Alfacalcidol is able to increase the expression of D-hormone receptors.

What are the theoretical prerequisites for the effectiveness of “Alfacalcidol” to prevent falls.

Treatment with Alfacalcidol increases the ratio of type II muscle fibers in elderly patients. The effectiveness of the drug does not depend on kidney function. “Alfacalcidol” increases the expression of D-hormone in all organs and tissues. Efficiency does not depend on the content of the level of vitamin D.

This must be proven. We cannot stop only at theoretical research. A meta-analysis that was conducted on the comparative efficacy of D-hormone analogues. In the first part – these are studies that were devoted specifically to “Alfacalcidol” or “Calcitriol” (“Calcitriol”). The following studies are those studies that were devoted to “Colecalciferol” – native vitamin D.

20:56

It has been shown that the use of “Alfacalcidol” and “Calcitriol” reduces the risk of falling by 21%. This was statistically significant, P=0.02. While the use of Colecalciferol did not increase statistically significantly, it did not reduce falls in patients (21,000 people). The differences between the use of active metabolites and native vitamin D for the prevention of falls were statistically significant.

Fall prevention cannot help but reduce the risk of non-vertebral fractures. The reduction in the risk of non-vertebral fractures in active metabolites is 49%, which is rarely observed.

If we select initially only those patients who have a known decrease in glomerular filtration rate (less than 65 ml / min), then they have a 71% reduction in the risk of falls. This was a study using Alpha-D3-Teva at a dose of 1 mcg. For these patients, the use of Alfacalcidol is hormone replacement therapy.

We decided to see how many women really have a decrease in glomerular filtration rate, who may need compensation for vitamin D deficiency and treatment with active forms of vitamin D.

We took 65 women who came to us in the winter to treat osteoporosis. 55% of them already had fractures. They measured their vitamin D levels. It was found that 85.5% of women needed vitamin D replacement therapy, 25% of them already had secondary hyperparathyroidism.

41% of the women in these patients had a decrease in glomerular filtration rate of less than 65 ml / min, that is, 41% of women are those patients who would potentially not be suitable for treatment with just Colecalciferol (restoration of vitamin D levels). Only 59% had a glomerular filtration rate greater than 65 ml/min. In such patients, the possibility of a decrease in the expression of D-hormone receptors should be considered.

23:18

How to select patients potentially in need of fall prevention. These are patients who have fallen more than once in the last year or have had serious injuries as a result of a fall. Decreased glomerular filtration rate less than 65 ml/min. Inability to perform a functional test.

Formulas for calculating creatinine clearance. They are available. On the Internet, you can also count at www.mdrd.com.
There is a “Chair rising” test. 5 times to get up and sit down without the help of hands as quickly as possible. If the test exceeds 10 seconds, then we are talking about a high risk of falls.

More tests that were obtained from a prospective study of almost 3,000 women. Failure to stand on one leg for 10 seconds increases the risk of a fracture by 9 times. The reason is that our patients cannot keep a balance. The inability to independently walk 100 meters, determined by the patient, increased the risk of hip fractures by 11 times. We can use these tests too.

I wanted to say a few words about the polyotropic effects of the D-hormone. It is expressed in many organs and tissues. Data on its effect on bone tissue and muscle tissue have been reliably studied. However, there is more and more discussion about the effect of D-hormone on reducing the risk of cancer. In particular, colon cancer, prostate cancer, breast cancer.

We think about its impact on autoimmune diseases. Some believe that low vitamin D levels may be a marker of autoimmune disease. This continues to be discussed. Influence on the cardiovascular system.

As an endocrinologist, I liked the pilot study conducted back in 2004. These were children and adolescents with type 1 diabetes who received Alfacalcidol for two years. After 2 years, those children who received Alfacalcidol had a slightly lower need for insulin. Perhaps we can talk about a protective effect on beta cells.

25:36

However, diabetes plays a large role in fractures. Type 1 diabetes mellitus refers to secondary osteoporosis. We see a 6-fold increase in the risk of fractures. For type 2 diabetes, we see a 1.7-fold increase in the risk of hip fractures.

We tried to compare how to identify the group of patients who have an increased risk of fractures. When they looked at the densitometry, it was not at all impressive.

According to these data, only type 1 diabetes should slightly increase the risk of hip fracture. While type 2 diabetes actually has a protective effect. It even reduces the risk of hip fractures.

However, the real risks of fractures for type 1 diabetes were 6 times higher than the densitometry data. For type 2 diabetes, there was also a statistically significant increase in the risk of fractures.

We tried to see why. It was a multivariate analysis. 124 thousand cases of fractures, 374 thousand cases of control. Indeed, diabetes itself without complications increased the risk of fractures, that is, collagen glycation.

Multiple complications also affected the risk of fractures. But if we single out individual complications, then only diabetic nephropathy had a statistically significant effect on the increase in the risk of fractures. In patients with diabetes, we are talking primarily about hip fractures. Perhaps this was also due to a decrease in the glomerular filtration rate.

In conclusion, I want to remind you that a decrease in bone mineral density of the femoral neck by one standard deviation does increase the risk of hip fracture by a maximum of 2.7 times. However, the fact of falling sideways increases the risk of a hip fracture by 5.7 times.

In conclusion, I would like to address you with an appeal from the World Health Organization. We must pay great attention to the problem of falling, to work. For this, governmental and non-governmental organizations, Media and medicine are involved.

28:00

Status assessment – these are social services, courtyards, building projects, leisure of the elderly, social integration of the elderly, identification of the highest risk groups. The work of many public organizations.

Intervention is the prerogative of medicine. You and I must be responsible for education, changing behavior, adapting an elderly person to his changed physical condition. Exercise programs should be developed and actively implemented. These are balance exercises. Now a lot of attention is paid to Tai chi. Exercises to increase muscle strength.

Of course, medical intervention. Among non-specific drug interventions, the most attention today is paid to Alfacalcidol as a drug that has proven efficacy in randomized controlled trials in combination with a pathogenetic justification.

Thank you very much for your attention.

Oksana Drapkina: Thank you very much, Zhanna Evgenievna.

Prevention of falls in the elderly

Prevention of falls in the elderly

Thousands of older people fall every year…Many of them suffer serious injuries, including fractures (most often in the femoral neck, hands, pelvic bones, vertebrae). Falls often occur for various reasons, and many of them are preventable.

Falls are the most common and serious household accident among the elderly. Nearly a third of people over 65 and half of people over 80 experience a fall at least once a year. Every second person over 85 loses the ability to move independently after a fall. However, many older people and their families do not perceive the risk of falls as an important issue. Only 10% of older people take steps to prevent falls and related injuries.

The consequences of a banal everyday fall can be a death sentence not only for a seriously ill patient, but also for a completely prosperous elderly person. Falls are a danger signal! The likelihood of falls can be predicted based on the available diagnostic criteria, and the risk of falling can be reduced in a variety of ways, including general health, medical and household activities. If you fall, be sure to tell your doctor or geriatrician about it.

Top 10 causes of falls

1. Muscle weakness.

If “the legs don’t hold” and there is no strength in the arms to get up or prevent a fall. What should be done? Make sure you get at least 150 minutes of physical activity a week. Strength and balance exercises are especially important to prevent falls. If for health reasons you are not able to perform the specified amount of physical activity, then try to be physically active as much as your condition allows. Make sure your diet includes the required amount of protein, as well as 1.5-2 liters of fluid.

2. Impaired gait and balance.

What should be done?

When walking, use walking aids such as a cane or walker, which must be properly fitted. Contact your doctor for advice.

For walking outdoors during icy conditions, use special devices that are worn on shoes – “ice drifts” or “winter walks” – they significantly reduce the risk of falls. If you notice that you have episodes of dizziness, palpitations, you lose consciousness or are in a “faint” state, contact your doctor.

If you have a history of falls, it is recommended to use hip protectors to prevent hip fracture.

3. Osteoporosis

What should be done?

Osteoporosis can go unnoticed by a person. A dangerous consequence of osteoporosis is fractures. The most common are fractures of the radius and femur, as well as compression fractures of the spine. The latter can occur completely unnoticed by a person and, as a rule, make themselves felt in the form of chronic back pain. Note! A decrease in height of 4 cm or more compared to height at the age of 25 years is considered one of the clinical manifestations of osteoporosis. X-ray densitometry (measurement of bone density) is used to diagnose osteoporosis and monitor the effectiveness of treatment. Consult with your doctor, check the level of vitamin D and blood calcium. If necessary, have X-ray densitometry (measurement of bone density). To prevent osteoporosis, it is recommended to take vitamin D supplements (consult your doctor before taking it). Your diet should be complete and include enough calcium.

Remember that strength training helps to maintain bone strength and prevent or slow down the development of osteoporosis

4. Feeling of “tingling in the legs”, numbness, changes in sensation, unpleasant and painful sensations in the legs, leading to a restriction of daily activities

What should be done?

If you notice these symptoms, you should contact your doctor. To exclude diabetes, check the level of glucose and blocked hemoglobin in the blood. If you already have diabetes, monitor your blood glucose levels with a glucometer. Check with your doctor about what blood glucose numbers you should have on an empty stomach and two hours after eating to minimize the risk of complications. Don’t forget about exercise.

Thyroid function screening (TSH) is recommended if these symptoms are present. If you smoke, stop smoking immediately.

5. Certain drugs, 5 or more drugs per day

What should be done?

Discuss therapy with your doctor or geriatrician. You may be able to stop taking certain medications. Do not take medications that are not recommended for you, especially psychotropic drugs, sleeping pills or sedatives. They can cause falls.

6. Visual impairment

What should be done?

See an ophthalmologist as soon as possible in case of visual impairment. Get checked out by an ophthalmologist every year. When going up or down stairs, do not wear multifocal glasses (glasses that combine lenses with different diopters). In the first days or weeks after vision correction (for example, new or first-time prescription glasses, surgery), the risk of falls may increase.

7. Pain syndrome, joint and muscle pain

What should be done?

Seek medical attention as soon as possible if pain occurs. It is likely that chronic pain will require long-term medical and non-pharmacological treatment. Physical activity and some exercise often improve pain control.

8. Memory impairment, mental decline, dementia.

An elderly person may be confused, forget the rules of the road, be inattentive when moving on the street and at home

What should be done?

At the first signs of impaired memory or other mental abilities (thinking, attention), consult a neurologist as soon as possible. Family and community support is essential. Cognitive training is recommended.

9. Depression, decreased mood, lack of desire, loss of interest in life, communication

What should be done?

Family and community support is important. If necessary, consult a psychotherapist or geriatrician

10. Pay attention to home improvement

What should be done?

The house must be equipped so that an elderly person can move freely around it. Remove unstable objects, organize sufficient lighting in rooms and corridors, “on duty” light at night, lay anti-slip mats in the bathroom, wear comfortable shoes with a back.