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dmcfarlane
02-22-2009, 07:59 AM
Dear All,

Here is my summary of the many responses to my question about exercise for seniors for fitness and weight control (many thanks to all of you!):

Genna Mulvey (Developmental Neuromotor Control Lab, University of Michigan) provided
two very useful references; Hughes et al, 2002 and Gallagher et al, 2000. Here is the gist of those references;

* A longitudinal study of men and women aged over 60 found that the amount of body fat increases by about 7.5% per decade while Fat Free Mass (FFM i.e lean tissue) decreases by 2% per decade (Hughes et al, 2002). The authors concluded that contribution of weight gains and lifestyle changes (such as regular resistance exercise) for minimizing lean-tissue loss due to ageing still requires further research. .

* Research shows that sarcopenia is a progressive process in elderly men in their early seventies and it occurs even in healthy independently living older adults who do not manifest any weight loss (Gallagher et al, 2000). This is because while their total skeletal muscle mass decreases their total fat mass increases.

Dale Chapman pointed out that an Australia-wide seniors exercise program called "Living Longer Living Stronger" has been running nationally for at least 3 yrs now. "Living Longer Living Stronger" is a strength-training program for people over the age of 50 years. This program works to maximise opportunities for older people to participate in low-cost, supervised group training sessions. It aims to promote the benefits of living longer and stronger such as increased physical and mental health, quality of life, increased capacity for activities of daily living and decreased prevalence and severity of a range of health problems of the aged including obesity, high blood pressure, diabetes, osteoporosis and depression.
Its website is http://www.dva.gov.au/health/health_wellbeing/living_longer.htm

He also mentioned that Prof Rob Newton and his team at Vario Health Institute from Edith Cowan University have been investigating resistance exercise in this population for lifestyle reasons. They also have at least three people working on this topic including Zoe Gibbs, Kyle Smith and Jeremiah Peiffer.

Brett Fforde (James Cook University) commented that the missing link in any exercise and fat loss study is dietary control. He noted that much of the foods promoted as "healthy eating" are far from health giving. He mentioned that the Crossfit philososphy of exercising had opened his eyes to alternative nutrition philosophies. He is planning to convert to a Paleolithic diet and/or the Zone diet because of the dangers of hyperinsulinism and excessive amounts of high GI carbohydrate in the "normal" diet.
He provided this link: http://www.thepaleodiet.com/articles/JANA%20final.pdf

After Googling his leads I found one particularly useful paper. One study found that aerobic exercise training can be useful for treating metabolic syndrome and the prevention of chronic diseases (Katzmarzyk et al, 2003). In this study the presence of the metabolic syndrome and component risk factors were determined before and after 20 wk of supervised aerobic exercise training. After the training 32.7% of male and 28.0% of female participants with metabolic syndrome were no longer classified as having the syndrome.

Incidentally in that instance "Metabolic Syndrome" was defined as the presence of three or more of these risk factors: elevated waist circumference, blood pressure, triglycerides, blood glucose and low HDL cholesterol. There appears to be some disagreement as to whether it means hyperinsulinemia (hyper-insulism or "insulin resistance"), hyper-homocysteinemia (elevated homocysteine or Syndrome X), or merely middle aged male-pattern adiposity (or some combination of these).

David Dillard (Temple University) suggested that the elderly need food supplementation and provided some information on the effect of beta alanine supplementation on neuromuscular fatigue in elderly. He said that according to Jeffrey Stout (University of Oklahoma) providing dietary supplements of Beta-alanine to the elderly could be helpful for the prevention of falls and maintaining their ability to live independently (Stout et al, 2008). Beta-alanine (a precursor to carnosine) is needed in muscles because it plays an important role in the maintenance of efficient muscle functioning during intense exercise; consequently a dietary supplement of beta-alanine leads to improvements in muscle strength and endurance. This research has shown that a diet supplement with beta-alanine for 90 days provides an improvement in fitness comparable to those that would be achieved by endurance training over a similar period.

Lisa Kuipers RN very kindly sent me the link to "Supplement Improves Fitness for Elderly". Here it is: http://www.medpagetoday.com/PrimaryCare/Geriatrics/11665

Rod Whiteley sent me a reference on the "Effect of Exercise Training Intensity on Abdominal Visceral Fat and Body Composition" (Irving et al, 2008). This paper presented data that indicate that body composition changes are affected by the intensity of exercise training. High-Intensity Exercise Training (HIET) is more effective than Low-Intensity Exercise Training (LIET) for reducing total abdominal fat and subcutaneous abdominal fat and Abdominal Visceral Fat (AVF) in obese women with metabolic syndrome (Irving et al, 2008).

Matthew Tenan (Graduate Student, University of North Carolina-Chapel Hill, USA) suggested that I should contact Wayne Westcott because he has done some pretty extensive research in this area. He said that; "Most of his research surrounds the findings that even as "fit" people age and increase in BMI, their actual health is more grim than their BMI indicates. Even if the person only gains 5 pounds for each decade of life
after 30 yrs, they typically are gaining 7 pounds of fat and losing 2 pounds of muscle. He has been a strong advocate for resistance training for this reason.". Matt did not provide any
references but after a little Googling I soon located an article by Wayne Westcott on the value of exercise for an over-fat population (Westcott 1998) The article describes how a program of combined strength and endurance exercises for seniors can produce encouragingly healthy weight losses due to a combination of fat loss and muscle gains. See "Exercise: Does It Work For The Overfat Population?" by Wayne L. Westcott (1998):
http://www.healthy.net/scr/column.asp?ColumnId=12&Id=230

After a search of the National Library of Medicine website I located a recent paper by Wayne L. Westcott. The bad news is this study showed that the aerobic exercises long in vogue are not hugely effective for making out-of-condition Air Force personnel fit. The good news is that shorter and less frequent strength-training exercises are more effective. A 12 week study was conducted to contrast the effectiveness of a longer and more frequent aerobic exercise protocol with a shorter and less frequent circuit strength-training protocol. The researches found that fewer participants in the standard conditioning group achieved a pass than those in the circuit strength-training group (Westcott et al, 2007). Only 19% of the people doing the aerobic exercises passed compared with 26% on the shorter and less frequent circuit strength-training protocol.

These new leads led me to some other useful references;

* Exercise training reduces the amount of body weight that is lost as "fat-free mass" during diet-induced weight losses (Ballor and Poehlman, 1994), i.e. exercising while dieting causes the body to lose fat rather muscle mass. The amount of muscle mass lost due to dieting can be approximately halved by exercise training.

* A study at Tufts University showed that resistance training is an effective way to decrease body-fat in healthy older people and may be useful as an adjunct to weight-control programs for older adults (Campbell et al, 1994). It also helps to maintain the mass of metabolically active tissues such as muscle.

I also found two related articles that provide useful insights:

"High Intensity Strength Training For Better Body Composition" by Wayne L. Westcott,:
http://www.thesportjournal.org/article/high-intensity-strength-training-better-body-composition

"Does Your Metabolism Slow Down As You Age?" by Dr. Paul Lanthois (September 06, 2008): http://www.americanchronicle.com/articles/view/73378

Later on I contacted Wayne Westcott and he alerted me to the latest ACSM (American College of Sports Medicine) position paper on "Appropriate Physical Activity Intervention Strategies for Weight Loss and Prevention of Weight Regain in Adults";
http://www.acsm.org/AM/TemplateRedirect.cfm?template=/CM/ContentDisplay.cfm&ContentID=12153.

Sean Mullen noted that there is a push now for "metabolic fitness" because you can arguably achieve this with constant exercise levels of exercise at any age (or weight). He mentioned that there is data to show that at certain ages an increase of about ten percent in body-fat per decade is associated with a decrease in mortality rates, whereas a ten percent decrease in body-fat with age is associated with an increase in mortality rates.

I tried to find some published papers supporting this contention and I eventually found some interesting papers. Weight gain in early adulthood is more dangerous than weight gain in later life Severe weight gain between the ages 25 and 40 is associated with a higher risk of type 2 diabetes (1.5 times greater for men 4.3 times greater for women) than a "stable weight in early adulthood" or a "weight gain in later life" (Schienkiewitz et al, 2006). Similarly weight gain and smoking in "early adulthood" (25 to 40) are the most important predictors of virulent prostate cancer (Spitz et al, 2002). A similar pattern is found for Coronary Heart Disease (CHD). The Honolulu Heart program found that weight gains between the age of 25 and 55 are associated with a high risk of CHD but after the age of 55, weight-loss is associated with a higher risk of CHD (Galanis et al, 1998).

Joseph Munaretto (Graduate Student, University of Southern California) queried whether the articles I cited have made adjustments for other variables that may change with age (eating habits, sleep, etc) when comparing how much exercise individuals do as they get older. An excellent point, Joseph; I rather doubt it. He mentioned the concept that after middle age only
50% of aging effects are actually do to the physiological process of aging while the rest are due to other factors that change with age. Has anyone got a good reference for this concept?

Rod Whiteley commented that in his experience during the last 20 years or so is that a dietary axiom has a half life of about 5 years and there just isn't enough good data on the side effects of their recommendations or provide us with enough information about many of the issues (such as fasting). He agreed with my point about the dangers of making extrapolations from sample populations to the general population. As he put it "Assuming that something that is going on in the body of a university student or military recruit is going to be the same as that of a middle-aged housewife, or early retiree borders on a non sequitur."

David Morgan commented that having reached age 60 with the same body weight as he had had at 21 and "essentially no exercise, certainly no running or gym work, in those
years", he would seem to be the example that disproves his statement. He commented that "It is just a matter of eating sensibly. You are only considering energy expenditure and ignoring intake. Overeating can cause weight gain for almost any level of exercise, but weight gain with age is certainly not inevitable; I am the living proof of that. More importantly for setting targets, the weight that causes problems is not age dependent." A moot point!

Eric Buse suggested that a program including running routine and resistance training and/or weight lifting would be highly beneficial because maintaining substantial muscle mass in combination with running training tends to burn a lot of calories.

David Vaughan (Institute for Biomedical Research into Human Movement and Health, Manchester Metropolitan University) pointed out that BMI is a very poor indicator of body fat and weight gain. He noted that running predominantly exercises the heart. He commented that the intensity of exercise probably decreases as you age if you exercise at a low intensity hence the exercise ceases have many benefits. Conversely "short high intensity bouts, coupled with weight baring exercises, which speed up the metabolism are more
beneficial to maintaining a "healthy" weight." Consequently "Physical activity guidelines for maintaining a healthy weight are undoubtedly too low" as it is the "type and intensity of exercise that is important" because it's not the weight gain or excess weight in itself that is "bad" it's the type of weight gain i.e. too much fat.

Last (but not least) Irene Di Giulio of the Institute for Biomedical Research into Human Movement and Health, Manchester Metropolitan University observed that many studies on aged people tend to use people aged over 65.

In summary it appears that:
* Resistance and endurance training exercises are useful for both reducing the weight of older people and maintaining their muscle mass.
* Supplements can assist older people to build muscle mass (and they can also be helpful for treating metabolic syndrome in some cases).
* Adequate exercise appear to be vital for people on weight-loss programs.


Regards,

David McFarlane MAppSc (Ergonomics)
Ergonomist, WorkCover NSW

1. Hughes VA, Frontera WR, Roubenoff R, Evans WJ, Singh M, (2002), "Longitudinal changes in body composition in older men and women: role of body weight change and physical activity", Am J Clin Nutr, 2002 Aug, 76, (2), pp 473-81. Hyperlinks:
http://www.ncbi.nlm.nih.gov/pubmed/12145025 and http://www.ajcn.org/cgi/content/full/76/2/473

2. D Gallagher, E Ruts, M Visser, St Heshka, R Baumgartner, J Wang, R Pierson, F. Xavier Pi-Sunyer and S Heymsfield, (2000), "Weight stability masks sarcopenia in elderly men and women", Am J Physiol Endocrinol Metab, 279, pp E366-E375.
http://ajpendo.physiology.org/cgi/content/full/279/2/E366

3. Katzmarzyk PT, Leon AS, Wilmore JH, Skinner JS, Rao DC, Rankinen T, Bouchard C., (2003), "Targeting the Metabolic Syndrome with Exercise: Evidence from the HERITAGE Family Study", Med. Sci. Sports Exerc., Vol. 35, No. 10, pp. 1703-1709.
http://www.ncbi.nlm.nih.gov/pubmed/14523308

4. J Stout, B Graves, A Smith, M Hartman, J Cramer, T Beck and R Harris, (2008), "The effect of beta-alanine supplementation on neuromuscular fatigue in elderly (55-92 years): a double-blind randomized study" Journal of the International Society of Sports Nutrition, 2008, 5, 21. http://www.jissn.com/content/5/1/21

5. B Irving, C Davis, D Brock, J Weltman, D Swift, E Barrett, G Gaesser and A Weltman, (2008), "Effect of Exercise Training Intensity on Abdominal Visceral Fat and Body Composition", Med. Sci. Sports Exerc, Vol. 40, No. 11, November 2008, pp. 1863-1872. http://www.medscape.com/viewarticle/584083

6. Westcott WL, Annesi JJ, Skaggs JM, Gibson JR, Reynolds RD, O'Dell J, (2007), "Comparison of two exercise protocols on fitness score improvement in poorly conditioned Air Force personnel", Percept Mot Skills, 2007 Apr, 104, (2), pp 629-36.
http://www.ncbi.nlm.nih.gov/pubmed/17566453

7. Ballor D and Poehlman E, (1994), "Exercise-training enhances fat-free mass preservation during diet-induced weight loss: a meta-analytical finding", Int J Obes Relat Metab Disord, 1994 Jan, 18, (1), pp 35-40. http://www.ncbi.nlm.nih.gov/pubmed/8130813

8. Campbell WW, Crim MC, Young VR, Evans W, (1994), "Increased energy requirements and changes in body composition with resistance training in older adults", Am J Clin Nutr, 1994 Aug, 60, (2), pp 167-75. See http://www.ncbi.nlm.nih.gov/pubmed/8030593 or
http://www.ajcn.org/cgi/reprint/60/2/167

9. Schienkiewitz A, Schulze MB, Hoffmann K, Kroke A, Boeing H, (2006), "Body mass index history and risk of type 2 diabetes: results from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study", Am J Clin Nutr, 2006 Aug;84(2):427-33
http://www.ncbi.nlm.nih.gov/pubmed/16895894.

10. Spitz MR, Strom SS, Yamamura Y, Troncoso P, Babaian RJ, Scardino PT, Wheeler T, Amos CI, von Eschenbach A, Kagan J, (2002), "Epidemiologic determinants of clinically relevant prostate cancer", Int J Cancer, 2000 May 20, 89, (3), pp 259-64.
http://www.ncbi.nlm.nih.gov/pubmed/10861502

11. Galanis DJ, Harris T, Sharp DS, Petrovitch H, (1998), " Relative weight, weight change, and risk of coronary heart disease in the Honolulu Heart Program", Am J Epidemiol, 1998 Feb 15, 147, (4), pp 379-86. http://aje.oxfordjournals.org/cgi/reprint/147/4/379

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