Ageing - Nutrition And PA

Question 1

What are the common physiological consequences of ageing?

Answer 1

Loss of muscle mass,
Decline in muscle function,
Decline in VO2 max and CRF (changes in ventilatory and CV function)
Decline in power,
Decline in fibre size and number, 
Changes to body composition, 
Sarcopenia,
Composition of muscles,
Decline in muscle strength,

Question 2

Whats the typical decline rate of muscle mass?

Answer 2

0.5-1% p/yr, accelerating after 65 yrs.
When accompanied by disuse, more rapid decline
Leads to ‘threshold of disability’

Question 3

Which kind of fat is more prevalent in older adults and why is this bad?

Answer 3

Visceral and ectopic fat.
Older adults are less able to utilise this and it can interfere with cellular function and therefore organ function. It can also be associated with insulin resistance.

Question 4

Women lose muscle function earlier but in males it happens with a steeper decline

Answer 4

Fact

Question 5

What effect does ageing have on the VO2max of an endurance vs sedentary individual?

Answer 5

On an endurance trained individual, the decline is much steeper and there’s a bigger change. However, they remain with a VO2 max higher than those sedentary so still beneficial.

Question 6

At what rate does power decline with ageing?

Answer 6

6% p/yr, much more rapidly than strength, muscle mass etc.

Question 7

Unclear whether decreases in muscle = decrease in PA, or the opposite. However with ageing, those meeting PA guidelines decreases, especially in women.

Answer 7

Fact

Question 8

Which fibre type sees a greater decline with age?

Answer 8

Type 2 fibres

Question 9

Why does muscle strength decline with age?

Answer 9

Morphological changes (decreased fibre size and number),
Neural changes (denervation),
Decrease in muscle mass

Question 10

What changes to body composition can be seen with age?

Answer 10

Almost 50% decrease in muscle and an increase in fat and non muscle FFM

Question 11

What is Sarcopenia? And what is it related to?

Answer 11

Age related involuntary loss of skeletal muscle mass and function - muscle strength and/or physical performance.
It’s directly related to reduction in mobility/function, disability and frailty, onset of chronic conditions

Question 12

What are the mechanisms for sarcopenia?

Answer 12

Disuse - physical inactivity, immobility, zero gravity
Cachexia - weakness and wasting due to chronic illness
Endocrine changes
Inadequate nutrition / malabsorption
Age related - sex hormones, apoptosis, mitochondrial dysfunction
Anabolic resistance (reduced stim of muscle PS)

Question 13

How do you assess sarcopenia?

Answer 13

Assess muscle mass - anthropometry, BIA, MRI
Physical performance - get up and go test, stair climb power test, usual gait speed, short physical performance battery
Strength assessment - hand grip, peak expiratory flow, knee flexion/extension

Question 14

How could you optimise muscle protein synthesis?

Answer 14

Maximise anabolic potency and enhance anabolic sensitivity

Question 15

How could you maximise anabolic potency?

Answer 15

Increasing daily protein intake or meal by meal protein intake

Question 16

How could you enhance anabolic sensitivity?

Answer 16

Doing exercise prior to eating and co-ingesting other nutrients such as Leucine and Creatine.

Question 17

What’s the recommended protein intake for older adults?

Answer 17

1-1.2 g/kg BM

Question 18

Why is it recommended that older adults increase their protein?

Answer 18

To optimise MPS and therefore maintain their muscle mass to prevent common problems such as frailty, falls etc

Question 19

What is anabolic resistance and what does it mean for older adults?

Answer 19

Reduced stimulation of muscle protein synthesis.
It means older adults require more EAA to stimulate PS than younger adults, so they need to consume more protein to see the same effect.

Question 20

Protein and resistance training increases muscle mass in young and old adults. Combine diet with PA! This is to slow sarcopenia and maintain healthy muscle mass, not to get big. This comes with economic, social and health benefits.

Answer 20

Fact

Question 21

What are some of the potential barriers around increasing protein intake in elderly?

Answer 21

Protein is very filling and they have a reduced appetite.

Question 22

Low muscle strength is associated with higher risk of mobility limitations

Answer 22

Fact

Question 23

Smaller mid-thigh muscle area and greater fat infiltration in the muscle is associated with poorer lower extremity performance

Answer 23

Fact

Question 24

Why is lower limb muscle power important?

Answer 24

Correcting a displacement or movement error to prevent tripping/falling and reducing the severity of the falls effect.

Question 25

Why is it important to prevent falls?

Answer 25

They can cause injuries especially in frail individuals, loss of confidence and independence, can be very dangerous. Recurrent falls are often the reason for nursing home care.

Question 26

Multi-morbidity is associated with high mortality, reduced functional status, increased use of health care

Answer 26

Fact

Question 27

Higher CRF in middle-age is strongly associated with lower health care costs in later life

Answer 27

Fact

Question 28

Why is PA encouraged in older adults?

Answer 28

More successful ageing,
Reach a disability threshold later in life,
Lower risk of premature death - reduces mortality by 22%,
Benefits to health,
Improves sleep,
Healthy weight,
Manage stress,
Improve quality of life,
Reduces probability of developing T2D, CV disease, cancers, back and joint pain, falls,
Reduced risk of sarcopenia,
Increases their usual walking speed

Question 29

What are the PA recommendations for older adults?

Answer 29

> 150 mins/wk MOD intensity (walk, swim, cycle)
Or >75 mins/wk VIG intensity (run, sports, stairs)
Build strength 2x p/w (Yoga, carrying bags, gym)
Minimise sedentary time,
Balance 2x p/w (bowls, dance)

Question 30

What are some of the barriers surrounding PA in adults?

Answer 30

Their physical health - pain, risk of injury,
Mental health - fear of falling,
Preferences - dislike PA, lack of motivation, embarrassed,
Lack of guidance, intimidated, pushed too hard,
Poor environment - weather, hills, parking,
Organisation - expenses, limited facilities

Question 31

What is likely to encourage/facilitate PA in older adults?

Answer 31

Benefit their mental health - mood boost, reduce stress
Physical health - prevent health problems, weight loss
Enjoyment, awareness of importance, self efficacy,
Companionship, camaraderie, guidance,
Convenient location, public transport,
Free classes, flexi timetable, classes for diff ability’s

Question 32

Why is resistance training beneficial for older adults?

Answer 32

Improves muscle strength and general physical functioning,
Muscle power,
Performance, 
Gait speed,
Hypertrophy/maintenance of muscle mass, 
Reduces risk of falls, 
balance,
Bone mineral density

Question 33

How can adherence to PA be improved in older adults?

Answer 33

Increase the awareness, understanding and importance in populations,
Include supervised programmes with encouraging instructors,
Keep it cheap, fun and not too difficult

Question 34

Recovery in older adults (even trained) is much slower, in a study PPO was not restored after 3 days recovery. Older adults have increased susceptibility to EIMD and have impaired regeneration.

Answer 34

Fact