Compensatory muscle fiber hypertrophy in elderly men.

Muscle strength and muscle morphology have been studied three times during a period of 11 yr in nine elderly men. On the last occasion the average age was 80.4 (range 79-82) yr. Body cell mass decreased by 6% and muscle strength for knee extension, measured by means of isometric and concentric isokinetic (30-60 degrees/s) recordings, declined by 25-35% over the 11-yr period. Between 76 and 80 yr of age only the isokinetic strength for 30 degrees/s decreased significantly. Muscle fiber composition in the vastus lateralis did not change between 69 and 76 yr of age, but there was a significant reduction in the proportion of type IIb fibers from 76 to 80 yr. The decrease in type II fiber areas was not significant between 69 and 76 yr of age (as in a larger sample from the same population), but a significant increase in both type I and type II fiber areas was recorded from 76 to 80 yr of age and biceps brachii showed similar tendencies. In the same period, the enzymatic activities of myokinase and lactate dehydrogenase subsided in the vastus lateralis, but there was no change for triose phosphate dehydrogenase, 3-hydroxy-CoA-dehydrogenase, and citrate synthase. The muscle fiber hypertrophy in this group of elderly men with maintained physical activity between 76 and 80 yr of age is interpreted as a compensatory adaptation for the loss of motor units. In addition, the adaptation with respect to oxidative capacities seems to be maintained at this age.

Training can improve muscle strength and endurance in 78- to 84-yr-old men.

Nine men, 78-84 yr of age, participated in a dynamometer training program 2-3 times/wk, totaling 25 sessions, using voluntary maximal isometric, concentric, and eccentric right knee-extension actions (30 and 180 degrees/s). Measurements of muscle strength with a Kin-Com dynamometer and simultaneous electromyograms (EMG) were performed of both sides before and after the training period. Muscle biopsies were taken from the right vastus lateralis muscle. The total quadriceps cross-sectional area was measured with computerized tomography. Training led to an increase in maximal torque for concentric (10% at 30 degrees/s) and eccentric (13-19%) actions in the trained leg. The EMG activity increased at maximal eccentric activities. The total cross-sectional quadriceps area of the trained leg increased by 3%, but no changes were recorded in muscle fiber areas in these subjects, who already had large mean fiber areas (5.15 microns 2 x 10(3)). The fatigue index measured from 50 consecutive concentric contractions at 180 degrees/s decreased and the citrate synthase activity increased in all but one subject. The results demonstrate that increased neural activation accompanies an increase in muscle strength at least during eccentric action in already rather active elderly men and that muscle endurance may also be improved with training.

Morphology of the paravertebral muscles in adolescent idiopathic scoliosis.

Histochemical studies of paravertebral muscles in idiopathic scoliosis have shown a consistently higher proportion of type I fibers on the convex side. In this study of the transversospinal muscles in moderate idiopathic scoliosis, we could demonstrate a lower type II B/II A fiber ratio on the convex side, along with an increased proportion of type I fibers. The capillary count was also higher on the convex side, especially around the type I fibers. The few pathologic changes found were predominately seen in the gravest cases of scoliosis. It is concluded that the fiber type distribution, capillary count, and metabolic enzyme activity on the convex side resembles that seen after endurance training. This suggests a secondary adaptive origin of these changes.

Effect of a training programme for pensioners on condition and muscular strength.

Physical training was performed by 22 women aged between 63 and 84 yr and 4 men aged between 74 and 86 yr twice a week for 10 mths. Some subjects had moderate disorders but all of them lived in their own homes. Apart from using body weight and elastic bands, no special equipment was used as resistance. Emphasis was laid on training muscular strength and not especially on endurance training. The effect of the training on physical fitness and muscular strength is presented in the 15 women who, according to predetermined criteria, were able to perform the tests adequately. A conditioning effect was detected by using a product of watts and minutes. The static and dynamic (isokinetic) muscular strength in the knee-extensors increased (6-13%) and, parallel with this, there was an increase in the relative FTa fibre area in the vastus lateralis muscle. The training programme in this study seems to be safe for an older population with diverse disorders, as only one negligible medical incident occurred. The present findings, with objective improvement in physical fitness with training combined with feelings of increased vigour, supports the use of gymnastic activity for pensioners and other means of stimulating the elderly to keep physically active even when they have moderate disorders. Improved physical fitness may help to prevent age-dependent impairments.

Effects of a training programme for elderly people on mineral content of the heel bone.

Physical inactivity can cause rapid bone loss. Different forms of physical activity are recommended for osteoporosis. The scientific background for such recommendations, however, is usually weak. This study was performed to evaluate whether it is possible to influence bone mineral content in elderly people by regular exercise. A total of 15 women with a mean age of 72 yr took part in a study in which they were given 1 h of training twice a week for 9 mth. Physically inactive patients from an outpatient geriatric unit served as a control group. They were matched in age and did not suffer from diseases that affect the locomotor system. After 10 mth of training no significant increase in bone mineral content, measured in the heel bone, could be found among the participants in the training group. Bone mineral content in the trained subjects was however, significantly higher after this training period than in the control group. The decrease in bone mineral content in the control group was almost the same as in a representative group of the population aged 70 to 79 yr. The cause of the decreased loss of bone mineral content in the physically-active subjects in the study could not be determined, but some contributing factors are discussed. Thus, it appears that physical activity diminishes bone loss due to age and that physical training has a positive effect on bone mineral content compared to that of nonactive controls of the same age. As there are no negative side effects, it has advantages over other forms of therapy, such as pharmacological treatment.

[The Svalebo program--successful rehabilitation of hip fracture patients]. / Svaleboprogrammet--framgångsrik rehabilitering för höftfrakturpatienter.

The aim of the Svalebo programme is improved rehabilitation and increased home discharge of patients with hip fractures, and a better use of health care resources. The programme includes contact with the hip fracture patients at the orthopaedic clinic, a rehab programme on an outpatient basis 1-3 days a week. As a result of the programme, the role of the day hospital has become clearer and the flow of patients through the orthopaedic department has increased, the mean duration of hospitalisation having decreased by 30 per cent. In a one-year follow up of 42 patients, it was found that in many cases hip function was incompletely restored. In general, our view is that the Svalebo programme assures good care and rehabilitation of the hip fracture patient, and decreased consumption of institutional care facilities.

Effect of physical training on skeletal muscle metabolism and ultrastructure in 70 to 75-year-old men.

The effects of a 12-week program of physical training on skeletal muscle (vastus lateralis) characteristics in 5 old men were investigated. Heart rates during submaximal bicycle exercise were decreased after training, indicating an improved cardiovascular function. As judged from enzyme activity measurements, the anaerobic capacity as well as the mitochondrial oxidative capacity were increased by the training. Fatty acid oxidation capacity remained unchanged, while the glycolytic potential tended to be increased, suggesting a somwehat different pattern of adaptation as compared to that seen in young subjects. Volume fractions of mitochondria and lipid droplets were unchanged with training, supporting the view that in old men, increases in oxidative capacity take place within the existing mitochondrial volume. It was concluded, that the aging human skeletal muscle remains trainable, and that the training response is similar, but possibly not identical, to that seen in younger age groups.

Evaluation of functional capacity in activities of daily living in 70-year-old men and women.

Various activities of daily living of importance for an independent and active life were studied in 70-year-old systematically selected men (n = 190) and women (n = 229) recruited from a population study. The tests concluded basal movements in the upper extremities in hygiene and dressing activities, ability to rise from a stool, function in the kitchen e.g. reaching shelves and tasks including pronation and supination of the forearm and measurements of comfortable walking speed. In a selected subsample, tests of ability to climb various step-heights and a manual ability test were also performed. As regards basal movements in the upper extremities in hygiene and dressing activities, the hand-to-toe test caused most problems. A minority of both sexes had difficulty rising from a stool and in performing the pronation-supination tests. Problems in the test of reach were mainly correlated to the height of the subject, presence of arthritic disorders, and positional vertigo. The mean walking speed was in both sexes lower than that recommended in Sweden as the norm for pedestrians at signalized intersections. All but one subject could climb up and down a 40 cm step using a handrail. Without using handrail one-fifth of the women but only a few men had problems at this step-height but all managed the 30 cm step. Both sexes showed a decline in manual dexterity compared to 20-30-year-old subjects. Correlations were found between muscle strength, step test results and walking speed as well as between walking speed and leisure-time physical activity. There was also a correlation between problems in handling the plug in the manual ability test and strength in the key-grip.

Isometric and isokinetic quadriceps muscle strength in 70-year-old men and women.

Isometric and isokinetic muscle strength during right knee-extension and maximal extension velocity were measured in forty men and thirty-two women, regarded as representative for the healthy seventy-year-old urban population. Muscle strength in women was on average 56 percent of that in the men. Equations for calculation of normal values from the individual's body height and weight are given. The maximal extension velocity of knee-extension was similar in both sexes. The subjects were classified with regard to previous occupational and leisure-time physical activity. An inverse correlation was found between muscle strength and previous occupational physical activity in the men.

Different kinds of services and informal support in the daily life activities in a community-based elderly population.

As part of the well-known population study of 70-year olds in Gothenburg, 1239 persons at the age of 70 were invited to participate in an extensive investigation and Inter-Vention program of the Elderly in Gothenburg (IVEG). The probands were examined at the ages of 70, 73 and 76 years. The purpose of this study is to describe different kinds of services and informal support in the daily life activities among three large groups of people in their seventies. A cross-sectional study design was chosen in order to get as large groups as possible. A home call was made by an experienced occupational therapist, who interviewed and observed the probands' performance in the daily life activities. The probands and their relatives were asked about the extent of different services and informal support. Personal and home assistance care given by relatives almost doubled between the age of 70 and 76 years. Help organized by the Social Welfare Services only increased marginally. Of the personal activities of daily living (ADL), getting in/out of a bathtub was the activity that caused most problems. The most common walking aid was a stick or a crutch, while use of a wheelchair was quite uncommon. Between the age of 70 and 76 years, the use of the Handicap Transport Service more than doubled. This study shows that at the age of about 73 years the elderly should be offered formal support, such as the supply of assistive devices. What is noteworthy is that the help from relatives and friends increased much more than the help from the Social Welfare Services between the age of 70 and 76 years. At present, relatives and friends assist the elderly in their homes to a large extent, and frequently. Relatives are doing an important job for their elderly and for society, and should be given every possible kind of public support and relief in order to have the strength to continue.

Muscle morphology, enzymatic activity, and muscle strength in elderly men: a follow-up study.

A follow-up study of muscle strength, muscle morphology, and enzymatic activity in 23 men, 73-83 years of age, was performed 7 years after the first investigation. With the exception of two men treated for congestive heart failure and four treated for hypertension, all were apparently clinically healthy and none had functional locomotor disturbances. Body weight was reduced by 2% and body cell mass by 6%, whereas the quadriceps muscle strength decreased 10%-22% over the 7-year period. Fiber composition in the vastus lateralis did not change significantly, and there was no significant difference between the biopsies from the biceps brachii and vastus lateralis. In the vastus lateralis, there was a reduction in fast-twitch fiber areas, which were smaller than in the biceps brachii (not studied at the previous investigation). There were also more histopathologic changes in the vastus lateralis than in the biceps brachii. The enzymatic activities of lactate dehydrogenase and myokinase, which were studied on both occasions in the vastus lateralis, did not change, and the activities of the other measured enzymes indicated a maintained metabolic capacity at high age. Oxidative enzymatic activities were higher in the vastus lateralis, and glycolytic enzymatic activities were higher in the biceps brachii, which could partly be explained by differences in relative fiber areas.

Muscle function in 75-year-old men and women. A longitudinal study.

Nine-teen men and twenty-one women, regarded as representative for the healthy seventy-five-year-old urban population were subjected to tests of lower and upper extremity function. The results were compared with those in the same probands at the age of 70. The investigation included tests of muscular isometric and isokinetic strength in knee-extension and flexion, isometric strength in key-grip, transversal volar grip, elbow-extension and flexion. Furthermore muscular coordination in hand and arm and submaximal endurance in hand-grip were measured. The subjects were classified with regard to physical activity. Between the age of 70 and 75 there was a significant decline in muscle strength in both sexes in the knee-extensors and a somewhat smaller in isometric than in isokinetic strength, and a decline also in the elbow-extensors and flexors. In a test of muscular coordination of the upper extremities and of maximal strength and submaximal endurance in hand-grip the results did not differ significantly between the age of 70 and 75. Isokinetic muscle strength in the knee-extensors and flexors was higher in men with a higher level of physical activity than in those with a lower activity. The results may indicate that the decrement of muscle strength in this age in part may be based on a changed activity pattern (note lack of change in hand-grip strength) with lack of fast and forceful movements in the daily living and speaks for the desirability that elderly people be physically active and that this may prevent disability.

Functional studies in 79-year-olds. III. Walking performance and climbing capacity.

Walking speed and the ability to climbing steps were studied in a subsample of 112 women and 93 men of the longitudinal population study "70-year-old people in Göteborg", in order to evaluate the functional capacity of the lower extremities. No women or men of this age achieved, when walking comfortably, a speed of maximum 1.4 m/s which is recommended in Sweden as a norm for pedestrians at signalized intersections. At their maximum walking speed only 32% of the women and 72% of the men reached 1.4 m/s. In comfortable walking women on an average used 78% and men 70% of their maximal walking speed. All subjects could climb up and down a 20 cm step when using a handrail. Less than half of the women but almost all the men were able to climb up and down a 50 cm high step using a handrail. Subjects having handicap transport service choose significantly lower walking speed than the rest of the subjects. Correlations were found between step test results and walking speed. It is concluded that both traffic vehicles and the rythm at signalized intersections are not in accordance with the functional capacity of older persons.

ADL-reduction and need for technical aids among 70-year-olds. From the population study of 70-year-olds in Göteborg.

Six hundred and nineteen persons from the population study of 70-year-olds "The intervention study of the elderly in Göteborg" (IVEG) were examined. They were interviewed in their home environment concerning their ability to manage activities of daily living (ADL), and the definition "ADL-reduction" is based on seven of these ADL-measurements. One third of the 70-year-old population had reduced ADL-capability, some only slightly. Joint disorders, paresis and congestive heart failure were the most common problems among the ADL-reduced subjects. Forty-three per cent of the ADL-reduced subjects (19% of total) received help with their personal care and/or housekeeping. One third had technical aid, mostly quite simple and inexpensive. Half were provided with new technical aids. The need for technical aids and home help service was noted and intervention undertaken as and when necessary. The needs were correlated to physical activity and performance in functional tests. The results do not illustrate the occurrence of handicap but are aimed at illustrating the special needs that elderly people may have in their normal surroundings.

Muscle adaptive changes in post-polio subjects.

Nineteen post-polio subjects (9 men and 10 women) aged 41-65 years were studied by means of muscle strength measurements (Cybex) of knee extension and muscle biopsies of the vastus lateralis for morphometric, histopathological and enzymatic analyses. Data from a reference group of 10 male subjects, age 42-51 years, are also given. Fourteen of the post-polio subjects had experienced a post-polio syndrome-like drop in function. All had had polio at least 25 years earlier. In nine of the 19 subjects, type I fibers accounted for more than 70% of the total. There was a significant negative correlation between muscle strength and the percentage of type I fibers in women. Large cross-section areas of muscle fibers were found, with an average mean fiber area of 8 microns 2 X 10(3). It is assumed that the large muscle fiber areas are due to an extreme use of the remaining muscle fibers in post-polio subjects with low muscle strength. There were significant negative correlations between muscle strength values and mean fiber area in men. Most subjects had single atrophic fibers; groups of atrophic fibers were less common. Internal nuclei and splitting were seen in about half of the subjects. The activity of citrate synthase was low, but normal for glycolytic enzymes.

Is there a change in relative muscle fibre composition with age?

Muscle biopsy was taken from the vastus lateralis muscle during surgery of recent fractures of the neck of the femur in 52 patients aged 66-100 years. The percentage of slow twitch (ST) fibres was close to 55% with no significant change with age and no difference between patients with and without clinical diagnoses prior to the fracture. Also subgrouping of fast twitch (FT) fibres showed insignificant changes in this age range. Muscle fibre areas were smaller for FT than for ST fibres. A comparison between proximal and distal sampling site in the muscle did not show any significant difference. Combining these results and previous results from our laboratories no change in relative fibre composition with age could be proven.

Impaired muscle function with aging. A background factor in the incidence of fractures of the proximal end of the femur.

Muscle biopsy material from vastus lateralis musculus quadriceps was obtained during surgery from 43 66-100-year-old female and nine 70-89-year-old male patients with fresh hip fractures. Before the accident, 18 women and two men were clinically healthy, and in the others, one-third had cardiovascular, one-third locomotor, and one-third neurologic disorders. Twelve women lived in institutions. The other women and all of the men lived in their own homes. A striking finding was a more advanced reduction in muscle fiber size in the vastus lateralis, especially in the fast twitch (FT) fibers. The reduction occurred in preaccident clinically healthy fracture patients. With advancing age, the proportions of the slow twitch (ST) and FT fibers remained the same. Well-maintained, enzymatic metabolic capacity, moderate neuropathic changes, and absence of myopathic changes indicate that the quality of the muscle tissue is relatively well preserved, even in elderly patients with hip fractures. Muscle fiber atrophy and weakness in muscle strength may be attributable in part to a low physical activity and are possibly reversible with exercise in some individuals.

Skeletal muscle metabolism and ultrastructure in relation to age in sedentary men.

In order to find out if there are age-related changes in human skeletal muscle metabolism or ultrastructure, biopsy material from 56 sedentary men aged 22-65 years was studied by means of enzyme activity determinations, histochemistry and quantitative electron microscopy. For comparison, a younger (16-18 years) and an older (66-76 years) group were included. These subjects were relatively more active. There was an increase in percentage of slow twitch fibres with age. Mitochondrial volume fraction decreased with age, primarily due to diminished mean mitochondrial volume. In spite of this, no overall decrease in the activities of five enzymes, representative of the major pathways in energy metabolism, was observed. Thus, increased amounts of enzymes per unit mitochondrial volume are implicated. Lipofuscin was more frequently found in the older groups. Correlations were present between fibre type distribution and oxidative enzymes, as well as between different enzymes. It was concluded, that the decrease in maximal oxygen uptake and muscular strength in aging humans probably may not be explained in terms of a deteriorating skeletal muscle energy metabolism.

Physical training in old men.

In order to investigate to what extent physical training might influence age-related changes in muscle strength and muscle composition, 12 70-year-old men were trained for 45 minutes three times a week for 12 weeks with dynamic and static exercise. The subjects in the study were free of cardiovascular and locomotor symptoms. After training the aerobic capacity was increased and static and dynamic muscle strength at all measured angular velocities increased significantly. In the control group none of these changes was seen. The fibre composition showed a significantly higher proportion of Type II fibres after training. Enzymatic evidence of training adaptation was found with significant increments in enzymes as muscle myokinase and lactate dehydrogenase. The results have shown that aerobic capacity and muscle strength are trainable in 70-year-old men.

Functional consequences of joint impairment at age 79.

A study of functional ability--in relation to joint impairment and disability--in 79-year-olds was performed on representative subsamples by interview (n = 134) and physical examination of joints (n = 89) as well as interview and functional tests regarding activities of daily living (ADL) (n = 84). Joint complaints of the lower extremities were more frequent than complaints of the upper extremities. Restricted knee motion had the highest correlation to disability of entering public transports. Previous sedentary workers were more disabled in ADL functions than those with a previous strenuous physical work. Correlation was found between low physical activity in the leisure time and impaired ADL functions. Low physical activity in the group with no definable disease was also correlated with greater social assistance. The reasons for commitment to institutional care were usually complex and, generally, not caused by joint impairment. Although disability had increased within the sample since age 70, at age 79 sixty per cent of the probands could still manage household tasks and personal care, and 69% did not require walking aids. The 79-year-olds thus display a high degree of musculoskeletal ability.