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A Journal on Physical Medicine and Rehabilitation after Pathological Events

Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
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Europa Medicophysica 2000 December;35(4):205-19

language: English

Physical exercise in the elderly: its effects on the motor and endocrine system

Capodaglio P.1, Narici M. V. 2, Rutherford O. M. 3, Sartorio A. 4

1 Centre for the Study of Motor Activities (CSAM) Institute of Pavia, “S. Maugeri” Foundation, IRCCS;
2 Department of Exercise and Sport Science, Manchester Metropolitan University, Alsager, UK;
3 Imperial College School of Medicine, London, UK;
4 Laboratory of Endocrinological Research (LSRE), Italian Auxologic Institute, IRCCS, Milan and Metabolic Diseases Unit III, Italian Auxologic Institute, IRCCS, Piancavallo (VB), Italy


Ageing is asso­ciat­ed ­with ­reduced max­i­mal aero­bic pow­er, mus­cle ­strength and pow­er; name­ly, ­reduced fit­ness. Based on the exist­ing evi­dence con­cern­ing exer­cise pre­scrip­tion for ­healthy ­adults, in 1990, the American College of Sports Medicine (­ACSM) ­made the fol­low­ing rec­om­men­da­tions: fre­quen­cy of train­ing: 3-5 ­days/­week, inten­sity: 60-90% HRmax, or 50-85% ˙VO2max, dura­tion: 20-60 min of con­tin­u­ous aero­bic activ­ity ­with involve­ment of ­large mus­cle ­groups. However, the tar­get of improv­ing/main­tain­ing phys­i­cal fit­ness is inap­pro­pri­ate for the ­whole eld­er­ly pop­u­la­tion, ­which ­includes the ­frail. In ­these sub­jects, the achieve­ment of a bet­ter ­health stat­us is cer­tain­ly the pri­mary ­goal, as recent­ly stat­ed by the 1996 Heidelberg guide­lines. Physical activ­ity ­should be pre­scribed on the ­basis of an indi­vid­u­al ­health/fit­ness gra­di­ent ­with dif­fer­ent ­goals. Lower lev­els of phys­i­cal activ­ity ­than ­those rec­om­mend­ed by the ­ACSM may ­reduce the ­risk for cer­tain chron­ic degen­er­a­tive dis­eas­es and yet may not be of suf­fi­cient quan­tity or qual­ity to ­improve ˙VO2max. In the ­wake of ­these con­sid­er­a­tions and the inclu­sion of the improve­ment/main­tain­ing of ­health stat­us ­among the ­goals of exer­cise pre­scrip­tion in the eld­er­ly pop­u­la­tion, in 1991, the ­ACSM low­ered the rec­om­mend­ed exer­cise inten­sity to as low as 35-40% ˙VO2max. One of the ­most crit­i­cal con­se­quenc­es of age­ing of the ­motor ­system is mus­cle weak­ness. Several caus­es may be ­held respon­sible for ­this phe­nom­e­non; ­among ­these sar­co­pe­nia is, prob­ably, the ­most com­mon. The lat­ter ­involves ­both a ­decrease in mus­cle ­fibre ­size and num­ber. However, atro­phy can­not ­alone entire­ly ­account for ­senile mus­cle weak­ness. As a mat­ter of ­fact, the max­i­mum ­force ­that may be gen­er­at­ed per mus­cle ­cross-sec­tion­al ­area (F/CSA) is low­er in eld­er­ly sub­jects. This phe­nom­e­non sug­gests ­that mus­cu­lar or neu­ral fac­tors, or ­more like­ly ­both, are ­involved. Another com­mon ­cause for the ­decrease in F/CSA is mus­cle acti­va­tion. Recent ­reports ­show incom­plete quad­ri­ceps mus­cle acti­va­tion in ­very old (80+) men and wom­en. Since ­almost com­plete (95%) mus­cle acti­va­tion was ­found in a pop­u­la­tion of sub­jects ~70 ­year old, it ­seems ­that acti­va­tion capac­ity rap­id­ly ­falls ­beyond the 7th ­decade. Therefore, tak­en togeth­er, the ­above neu­ral fac­tors may ­account for ­large ­part of the ­decrease in ­force ­with age­ing. Hormonal chang­es in them­selves are not the sim­ple expla­na­tion for all of the chang­es asso­ciat­ed ­with age­ing. Studying the ­effects of ­strength train­ing on the endo­crine ­system is com­pli­cat­ed by a varie­ty of fac­tors relat­ed to ­both the exer­cise chal­lenge ­itself and the accu­rate meas­ure­ments of hor­mones. The meas­ure­ment of hor­mo­nal chang­es is com­pli­cat­ed by the man­ner in ­which ­they are ­released, trans­port­ed and inter­act ­with the tar­get tis­sue. Many hor­mones are ­released in a pul­sa­tile man­ner ­with super­im­posed diur­nal, month­ly, and sea­son­al ­rhythms. They ­often ­exist in dif­fer­ent molec­u­lar ­weight frac­tions and are fre­quent­ly trans­port­ed in a ­bound ­form. From the ­work ­that has ­been car­ried out in young­er peo­ple it ­would ­appear, ­that if suf­fi­cient ­high resis­tance exer­cise is car­ried out, ­then the ­acute hor­mo­nal ­response is not qual­ita­tive­ly dif­fer­ent to ­that fol­low­ing a ­bout of endu­rance exer­cise. Exercise train­ing pro­grams ­have ­been sug­gest­ed as pos­sible coun­ter­meas­ures ­against invo­lu­tion­al ­bone ­loss, ­being ­able to pre­vent or ­reverse ­almost 1% of ­bone ­loss per ­year in ­both lum­bar ­spine and femo­ral ­neck for ­both pre- and post­men­o­pau­sal wom­en. As far as eld­er­ly peo­ple are con­cerned, it ­appears ­that ­strength train­ing may ­have a ­more ben­e­fi­cial ­effect ­than aero­bic train­ing on BMD, espe­cial­ly in post­men­o­pau­sal wom­en, ­although ­some evi­dence sug­gests ­that ­also aero­bic train­ing may ­improve BMD in the eld­er­ly. To ­date, the ­effect of phys­i­cal activ­ity on ­bone turn­over has ­received lim­it­ed atten­tion ­despite the ­strict depen­dence of ­bone ­mass on the bal­ance ­between ­bone for­ma­tion and ­bone resorp­tion. The equi­lib­ri­um ­between ­these two com­po­nents of ­bone turn­over is cru­cial for ­bone ­mass and BMD, ­since ­bone ­loss, or ­increase, ­results ­from an ­uncoupling of ­bone for­ma­tion and ­bone resorp­tion.
During the ­last few ­years ­there has ­been a rap­id devel­op­ment of reli­able meth­ods to meas­ure bio­chem­i­cal mark­ers of ­bone metab­olism. Since ­these mark­ers ­reflect the cel­lu­lar ­events, ­they may pro­vide new oppor­tu­nities to elu­ci­date the ­effects of phys­i­cal exer­cise on ­bone metab­olism.

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