Muscle Strength and Physical Performance of Older Adults

Impact of Resistance Training and Aerobic Exercise on Muscle Strength and Physical Performance of Older Adults

Abstract

With the continuous increase of world’s aged population, the need for their multi variant care approaches have become very important. Considering this, the aim of the current study is “explore the impact of the aerobic exercise and resistance training on the physical performance and muscle strength of the older adults”. In order to meet the aim, the researcher has conducted a secondary study, which included a thorough systematic literature review of the existing studies on the selected topic. Based on this, among several identified literatures, 20 key articles have been involved within the secondary thematic analysis. The findings revealed that the walking speed, muscle mass and muscle strengths are significantly improved through these exercises. It has also revealed that age related sarcopenia can be attenuated through these regimens. Improved results have been found for combined protocols. Finally, some alternative recommendations have also been provided to improve physical performance and muscle strength of older adults.

Chapter 1: Introduction

1.1 Background of the study

The population of older adults, especially above 65 years old people are increasing globally. As a result, the diversity of their age related health concerns are also increasing. Wide ranges of older adults are suffering from more than one chronic disorder, which reduce their quality of life significantly. In most of the cases, physicians and other health care professionals are emphasizing more on improving their quality of life through lifestyle management, rather than through medication management. In this context, a considerable interest has been noted in the role of physical activity related interventions for addressing the age related loss of musculoskeletal strength (Denison et al., 2013).Aerobic exercise and resistance training are exercises which are able to improve the muscle strength and improves several signs of the chronic diseases the older people have, along with improved quality of life. Aerobic exercise improves the heart and lung fitness, while strengthening the bones and muscles over time. Studies have also found that aerobic exercise has successfully activated the immune system among older adults, with better disease resistance and coping ability. Aerobic exercise is enabling the circulatory system to be more efficient to pump blood, while making the lungs more efficient to transport oxygen. Significant benefits of aerobic exercise have been noted for reducing the events like sarcopenia. It is mainly improving aerobic capacity, metabolic regulation and cardiovascular function, for improving the physical performance. Several existing studies have identified that such exercise regimen has improved the walking speed and immunity against the chronic diseases among older adults.

On the other hand, On the other hand, resistance training is also advised for the older adults, which makes the muscle to work against a weight or force. It is also a highly recommended type of exercise, for preventing age related sarcopenia and dynapenia. Considering this, the effectiveness of these interventions needs to be evaluated (Villareal et al., 2017).In this regards, the following study is going to focus upon exploring the impact of the aerobic exercise and resistance training on the physical performance and muscle strength of the older adults, through conducting a systematic review of existing literatures on the stud topic.

1.2 Rationale of the study

The world’s aged population is increasing day by day. It has been estimated that 125 million people are above 80 years old globally. In 2015, the population aged 60 years or over has been estimated to be 900 million (Villarealet al., 2017). With the growing population, the age related complications and disease rate is also increasing. With age, the muscle strengths reduce, along with others issues. However, the physicians and nurses are relying more upon the interventions, which are helping older adults to modify their lifestyle, which could improve their quality of life and enhance overall wellbeing. People nowadays are leading sedentary lifestyle, which is enhancing the chance of potential chronic health issues among the older adults. Physical exercise is one of the key interventions in daily life recommended by the health care professionals, which can make an older person healthy enough. With age, the muscle mass reduces, which is termed as sarcopenia. From a global systematic review, it has been revealed that the prevalence is 10% in men and 10% in women (NICE, 2013). The studies suggested that aerobic exercise and resistance training are significant way to reduce potential of sarcopenia and improve muscle functionality among the older adults. The aerobic exercise is improving the overall body functioning, while helping the older adults to deal with the chronic disorders like “type 2 diabetes, obesity, cardiovascular diseases” and others. In addition to that regular physical exercise is helping the older adults to improve their chronic disorders related to musculoskeletal system, including osteoarthritis, rheumatoid arthritis and other MSDs. On the other hand, the resistance training is helping to improve muscle strength. However, specific literatures are less in this area (Denison et al., 2013). This is the reason for analyzing effectiveness of aerobic exercise on performance and muscle strength of older adults.

As the global older population is increasing, the need for lifestyle management interventions is becoming more important. Physical exercise is one of the most important of these. The literature demonstrating the effect of exercise on the skeletal muscle function is available. However, the literatures demonstrating specific impact on the muscle functioning and physical performance of the older adults are less. Some studies have found positive results of the aerobic exercise upon the muscle strength and performance of the older adults (Henderson et al., 2017). A range of the studies have identified the role of aerobic exercise on muscle strengthen and performance improvement, focusing upon limited group of participants (Markofski et al., 2018). It is indicating that there is a need for analyzing the impact of “resistance training and aerobic exercise” upon the “muscle strengthening and performance improvement” of wider population of “older adults”. The current study is going to explore existing literatures and findings related to the issue, thereby helping to find overall solution for the issue.

The fall risk of the older adults, along with the fall related injuries are increasing, which are increasing the rate of lower physical performance and mobility issues among older adults. Such issues are putting significant stress on the research to identify the ways for improving older adult’s muscle strength. It has been estimated from the NHS report that falls are common, but overlooked causes of injury among the older adults in UK. It has also been revealed that approximately “1 in 3 adults over 65 years old”, living at home, experience at least one fall in a year. Half of these cases further increase the risk of further fall, due to weakened muscle strength and raised mobility issues. It has been estimated that falls of “older adults” every year is costing more than £2.3 billion for NHS in UK (NHS.uk, 2018). Therefore, such incidents due to reduced muscle strength and other age related factors, is having impact on the patient’s quality of life, health as well as healthcare cost. Undertaking immediate steps to reduce the incident rate could save a lot for the national healthcare system in the UK. Aerobic exercise and resistance training are an evidence based intervention (Aguirreand Villareal, 2015). However, it is crucial to analyze its feasibility and rate of success, indicating the need for conducting research now.

The current research is going to emphasize on the impact of “aerobic exercise” and “resistance training” on the “physical performance and muscle strengthening” of the “older adults”, thereby helping to resolve the research issue.

1.3 Aim of the research

Analyzing the research issue related to the older adults, it has been revealed that there is a significant need for conducting research on identifying the appropriate exercise regiment for the older adults, in order to improve their “muscle strengths and physical performance”. It will help the healthcare professionals to align their recommended practices with the appropriate aerobic exercise or resistance training schedule. Considering the, the researcher hasset the aim of the current study is to “explore the impact of the aerobic exerciseand resistance training on the physical performance and muscle strength of the older adults”.

1.4 Objective of the research

To achieve the above mentioned aim, the following objectives have been developed.

  • To conceptualize “aerobic exercise” and “resistance training” and their “benefits”
  • To analyze the impact of the “aerobic exercise” and “resistance training” on the “physical performance” and “muscle strength” of the “older adults”
  • To recommend ways for improving physical performance of older adults through alternative methods

1.5 Research hypothesis

H0: There is no significant impact of “aerobic exercise and resistance training on physical performance and muscle strength of the older adults”

H1: There is a significant positive impact of “aerobic exercise and resistance training on physical performance and muscle strength of the older adults”

1.6 Research Question

The above research objectives would be achieved through answering the below mentioned “research questions”.

  • What are the “benefits” of the “aerobic exercise” and “resistance training”?
  • What are the impacts of the “aerobic exercise” and “resistance training” on the “physical performance and muscle strength” of the “older adults”?
  • What could be recommended for improving physical performance of older adults through alternative methods?
  • Which are the most preferred aerobic exercises and resistance training for the older adults?
  • Why is physical exercise regiment for older adults needed?

1.8 A note on sarcopenia

Sarcopenia is referred to the age related condition, which is characterised as the “age related skeletal muscle mass”. With aging, the muscle mass reduces, which in turn reduces the quality and strength associated with aging. There are small monomuclear cells in the muscle fibres, known as the satellite cells which are usually activated upon injury or exercise. These cells are responsible for helping the muscles to maintain its function, upon differentiating and fusing into the muscle fibres, followed by injury or exercise. A scientific theory revealed that with age sarcopenia is caused by inability of the body to activate the satellite cells. Several factors could facilitate the condition, like lack of exercise, nutritional imbalance, muscle injury, age related MSD or sedentary lifestyle. As a result, due to impaired muscle functions, the quality of life of the older adults reduces significantly. It is considered as a key part of frailty syndrome. Several studies have identified that sarcopenia could be reduced by engaging the older adults in regular physical exercise regimen, like aerobic exercise and muscle strengthening exercise like resistance training.

1.6 Structure of the dissertation

Chapter

Description

Chapter 1: Introduction

In this “chapter”, the “researcher” mainly introduced the topic or the research issue. In the current research, the research issue is the “physical health” of the “older adults” and the role of aerobic exercise in improving their physical health. Considering this, the researcher has highlighted the rationale for conducting the study, followed by developing the “research aim, objectives and questions”.

Chapter 2: Research methodology

In this chapter, the researcher selects the most appropriate “research methods”, for conducting the “study”, aligning with the “purpose of the research”. In this context, it has been revealed that “secondary research methodology” is suitable for meeting the “research objectives” in the current study. Thus, the researcher has selected the methods suitable for secondary study.

Chapter 3: Literature review and secondary data analysis  

The key emphasis of this chapter is reviewing the existing literatures related to the research issue, to gain adequate knowledge on the research issue. In the current study, the literature review has explored different types of aerobic exercise and resistance training and how these are benefited to the “older adults”.

In this chapter, the key focus is analyzing the collected data from the available resources and interpreting those. In the current study, it has been done by analyzing and interpreting the key themes found from the secondary resources.

Chapter 4: Conclusion and Recommendations

In this final chapter, the researcher interpreted and concluded the study findings, linking the findings with the research objectives. Later, the researcher attempted to offer some key recommendations and the direction for future study.

Chapter 2: Methodology

2.1 Introduction

One of the key chapters in the research study is the methodology, which determines the best way to conduct the research. In this regard, it is notable that the researcher should align the purpose of the research with the appropriate methods. It is crucial for the researcher to consider the available methods and then decide the most appropriate method for the current study. It is necessary also necessary for the researcher to consider the ethical considerations of the research too. The current study has focused upon the impact of “aerobic exercise and resistance training” on muscle strengthening and physical performance of older adults. In this context, considering the wider nature of the research issue, it has been determined that the secondary study method is suitable for answering the research questions. Therefore, the following chapter is going to select the methods, suitable for secondary methodology.

Methods Outline

The information pertaining to the current study is broad and requires considerable filtration to extract relevant information; this deems the necessity for two strategies to be implemented in for meeting the above-mentioned “objectives”. The first will be; the “positivism philosophy, deductive approach and exploratory study design”, and the second will be a “secondary data collection and analysis” method. For the “collection of secondary data”, a systematic review would be conducted by searching important articles from the authentic online databases. These include: “Pubmed, Medline, CDU and Google Scholar”. Later, the “collected data” would be analyzed with the help of the “thematic analysis” method (Kumar, 2019).

2.2 Research philosophy

According to Silverman (2016) “research philosophy” is the way through which the “researcher” creates knowledge, while conducting a research study. It has been revealed that there are three key types of “research philosophies”, which are used by the researchers in different research, based on their nature, which include “positivism philosophy”, “interpretivism philosophy” and “realism philosophy”. Taking this into consideration, it is noteworthy that the key research philosophy that is going to be used here is the “positivism philosophy”. This enables the researcher to develop a logical and systematic study through empirical data collection and analysis, with the help of already existing scientific data, as it can fulfil the purpose of current study, which is why it has been selected here.

2.3 Research approach

The “research approach” determines the path of the “research”, i.e. whether there is a need for “hypothesis development” or “establishment of a new theory”. In this regards, two types of “research approaches” are being used in researches, including “inductive and deductive approaches” (Taylor et al., 2015). The “inductive approach” is assisting the “researcher” to develop a “research hypothesis first” and then to justify it with the empirical data collection and analysis. This particular research approach is being selected here, as it helped the researcher to explore the vast amount of pre-existing knowledge on the research area, instead of creating something new.

2.4 Research design

The “research design is something that denotes the “plan of the research”. Here, “three types” of “research designs” are used by the researchers in several studies, including the “exploratory, explanatory and descriptive”. However in this current study, the research will rely upon the “exploratory research design” (Kumar, 2019). That is because this particular type of research design is enabling the researcher to gather peripheral knowledge on the wider research area, and thereby in turn enriching knowledge base through exploring the existing research.

2.5 Data collection method

This is one of the “core steps” responsible for determining the fate of the research, so it is therefore crucial for the researcher to select the most appropriate “data collection method”. There are “two types” of “data collection methods” used by researchers, including “primary and secondary data collection methods”. Both the methods have some pros and cons (Mackey and Gass, 2015), however for the research purpose being undertaken, the “secondary data collection method” has significant benefits for conducting a research within a limited time period and availability of finance compared to the primary method. In addition, it is also suitable for conducting the research to focusing upon a wider area of interest or research issue. Considering this, the current research is relying upon “secondary data collection method”. This will enable the researcher to gather pre- existing data from the reliable resourcesand studies conducted, which are already established and shared by some other author. The current research is going to explore some key existing literatures on the study topic, for answering the research questions, through systematic literature review.

2.5.1 Search strategy

Selecting and executing an appropriate “search strategy” is crucial for all the researchers to conduct the study in the most relevant and systematic way. In the current study, for executing the search strategy, the PRISMA framework has been used, which offers a systematic way to execute the “literature search procedure”. The framework includes four steps for searching the literatures for the secondary research study, which include “identification”, “screening”, “eligibility” and “inclusion” (Neuman et al., 2014). In the current study, the search strategy included identifying most relevant and authentic online databases from where the literatures are selected. The databases used in the current study are “Pubmed, Medline, Google Scholar and CDU”. The researcher has selected some primary key search terms for the identification step, including “exercise”, “physical fitness”, “older adults”, “muscle strength”, “physical performance”, “resistance training”, “older adults” etc. In addition, some secondary keywords have also been used, combining the primary ones, to find the most relevant literatures. In this step, upon putting the primary and secondary search terms, 300 items were identified, which are similar to the study purpose. At this step, identification was done, based on the title of the articles. In the next step, screening, the articles were screened, for eliminating duplicates and unavailable ones, which are not available in full text form. This step ended with 198 articles. In the next step, the articles have been assessed, based on the eligibility or inclusion criteria. Further, the researcher developed the following inclusion criteria for including the most appropriate literatures:

  • Articles with well defined abstract
  • Articles published in English
  • Articles published after 2000
  • Articles, which are fully accessible
  • Articles title aligned with research purpose
  • Articles, which have conducting using methods “RCT, meta analysis, systematic review”

After the final screening with the above mentioned eligibility criteria, 20 articles have been included in the study.

Flow chart of search strategy

2.5.2 List of search articles

Author

Title

Year of publication

Taylor

“Physical activity is medicine for older adults”

2013

Tan et al.,

“Effects of Six Months of Combined Aerobic and Resistance Training for Elderly Patients with a Long History of Type 2 Diabetes”

2012

Gordon et al.,

“Effect of Aerobic Exercise (Walking) Training on Functional Status and Health-related Quality of Life in Chronic Stroke Survivors”

2013

Holvialaet al.,

“Effects of strength, endurance and combined training on muscle strength, walking speed and dynamic balance in aging men”

2011

Granacheret al.,

“Effects of Core Instability Strength Training on Trunk Muscle Strength, Spinal Mobility, Dynamic Balance and Functional Mobility in Older Adults”

2012

Beijersbergenet al.,

“The biomechanical mechanism of how strength and power training improves walking speed in old adults remains unknown”

2013

Cadore et al.,

“Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenarians”

2014

Meromet al.,

“Can social dancing prevent falls in older adults? a protocol of the Dance, Aging, Cognition, Economics (DAnCE) fall prevention randomised controlled trial”

2013

Villareal et al.,

“Aerobic or Resistance Exercise, or Both, in Dieting Obese Older Adults”

2017

Henderson et al.,

“Gait speed response to aerobic versus resistance exercise training in older adults”

2019

Bouaziz et al.,

“Effects of a short-term Interval Aerobic Training Program with Recovery bouts on vascular function in sedentary aged 70 or over: A randomized controlled trial”

2019

Bann et al.,

“Light Intensity Physical Activity and Sedentary Behavior in Relation to Body Mass Index and Grip Strength in Older Adults: Cross-Sectional Findings from the Lifestyle Interventions and Independence for Elders (LIFE) Study”

2015

Aguirre and Villareal

“Physical Exercise as Therapy for Frailty”

2016

Bakken et al.,

“Effect of Aerobic Exercise on Tracking Performance in Elderly People: A Pilot Study”

2001

Bowen et al.,

“Skeletal muscle wasting in cachexia and sarcopenia: molecular pathophysiology and impact of exercise training”

2015

Harber et al.,

“Aerobic exercise training improves whole muscle and single myofiber size and function in older women”

2009

Villareal et al.,

“Weight loss, exercise, or both and physical function in obese older adults”

2011

Martins et al.,

“Effects of short term elastic resistance training on muscle mass and strength in untrained older adults: a randomized clinical trial”

2015

Chiu et al.,

“Effects of resistance training on body composition and functional capacity among sarcopenic obese residents in long-term care facilities: a preliminary study”

2018

Mori and Tokuda

“Effect of increased daily intake of protein, combined with a program of resistance exercises, on muscle mass and physical function of community-dwelling elderly women”

2017

2.6 Data analysis method

Like the data collection methods, the “data analysis method” is also one of the most crucial parts of the “research methodology”, which relies upon the type of “data collected” and the data “collection method” selected in the study. In this regards, it is noteworthy that there are two types of “data analysis methods”; “researchers” are using in diverse study purposes, based on the data analysis method, which are “primary and secondary data analysis methods”. Aligning with the “data collection method” selected in the “current study”, the “secondary data analysis method” has been selected in the current study for analyzing the “data collected” from the “secondary data” (Flick, 2015). In this regards, it is noteworthy that the data collected from the “secondary literatures” through the systematic literature review, has been analyzed with the help of “thematic analysis”, which helps the “researcher” to find themes from the studies and analyze those accordingly.

2.7 Ethical considerations

It is crucial for the researcher to address all the ethical considerations, while deveoping the study. In this regards, the researcher has gathered the “ethical approval” from the “ethical committee” and then started the research work. Further, the researcher has followed the “Data Protection Act 1998” for ensuring that all the data collected from the research, are kept confidential and has not been used in any purposes, other than the “current research”. Additionally, the “researcher” has assured that all the data used in the “current study”, has been collected from the verified and authentic online database resources

2.8 Limitations

The study has considered only the secondary data collection and analysis. It has not included any primary data directly from the participants. Thus, there is a significant chance of including research bias, which might have compromised the achievement of the maximum study outcomes. However, inclusion of mixed method might have improved the quality of outcomes.

Chapter 3: Literature review and analysis of secondary data

3.1 Introduction

The literature review chapter is one of the most crucial chapters in the study, as it is helping the researcher to gain knowledge on the research area and conduct the further research in a systematic and logical way. In this context, the focus of the current study is upon the aerobic exercise and how it is helping the older adults to improve their physical performance and muscle strengths. Considering this, the following chapter is going to explore the key literatures available, which are helping the researcher to develop knowledge on the subject, i.e. aerobic exercise and the status of older adults, who need these types of exercise as well as the impact of such exercise regimen upon the older adults’ population (Bann et al., 2015).

3.2 Aerobic exercise

Marqueset al., (2017) defined the aerobic exercise as the type of physical exercise that is dependent upon the physiological “aerobic energy – development process”. These exercises could be of low to high intensity. As per the name implies, this type of exercise is helping the body system, especially the respiratory and cardiovascular system to use oxygen in aerobic metabolism, for meeting the demands of energy in the body, more specifically by muscle tissue, during the exercise. Supporting this, BÛouaziz et al., (2017) has revealed that Aerobic exercise is referred to as different types of cardiovascular conditioning, which improves the function of the cardiovascular system, as well as improving the overall function of the body’s’ musculoskeletal system. These types of activities are also known as “cardio” exercise. With aerobic exercise, the breathing and heart rate increases, this improves the overall functioning of the body system, as the body parts receive more oxygen per unit time (Marqueset al., 2017).Low to moderate intensity activities, supported by aerobic metabolism, can be referred to “solely aerobic exercise”; it is because of the nature of these activities, which are designed in such a way that all the consumed carbohydrates are transformed into energy through the aerobic metabolism pathway, instead of involving anaerobic pathway. The aerobic exercise and activities could include “brisk walking, swimming, running, or cycling” as well as other scheduled regimens, which are improving the cardiovascular performance.

Hsuet al., (2018) discussed that aerobic exercise is significantly different from that of the anaerobic exercises, like strength training or short distance running. The difference among the aerobic and anaerobic exercise differs in terms of the duration and intensity of muscle contractions engaged in the activities and the metabolic way through which carbohydrates consumed are developed in the muscle. While considering the benefits of these exercises, a new research by Diamond (2015) has shed light on the fact that these two types of exercises are influencing the myokine secretion, which activates several downturn pathways; thereby promoting “growth of new tissue, tissue repair and development of several anti-inflammatory functions”. As a result, risk of developing infectious diseases reduces significantly. However, secretion of myokines is dependent on the amount, intensity and duration of muscle contraction. It is helping both types of exercises to generate endocrine benefits. However, it is noteworthy in previous literatures that anaerobic exercise is convoyed by aerobic exercise. Due to high energy demands during exercise, the less efficient anaerobic metabolism supplements for meeting the capacity of aerobic metabolism.

3.3 Benefits of aerobic exercise

Aerobic exercise is one of the mostly used physical exercises, which can improve individual’s physical functional capacity significantly. A wide range of studies have identified the vasthealth benefits that can be attained fromaerobic exercise. In this regard, Wilsonet al., (2016) highlighted that this form of exercise is suitable for the older adults, who are having high risk of cardiovascular diseases, Increasing the capacity of heart and lung, this particular type of exercise is enabling the older adults to improve blood flow in the body parts, improved respiratory capacity, along with improved strength of muscles. In addition, several existing literatures have highlighted that following this regimen for a longer period strengthen and enlarge the heart muscle, enabling it to pump more efficiently; the phenomenon is known as “aerobic conditioning”, which is measured through the reduction in the resting heart rate. Further, improved blood circulation through the system reduces the risk of hypertension and related risks of the patients, like cardiovascular issuesand muscle atrophy.

Peraleset al., (2016) highlighted that in addition to the health benefits of the aerobic exercise, the type of exercise undertaken also possesses significant level of performance benefits, like improved gait balance, improved walking speed, improved cognitive abilities and others. Therefore, it can be said that the aerobic exercise is important for the older adults in order to improve their physical as well as brain capacity. Another study has specifically highlighted that among the older women, who are over the age of 60have significant reduction of bonerelated diseases such as osteoporosis. Furthermore, aerobic exercise has a significant benefits to deal with sarcopenia, while enabling the musculoskeletal system to increase muscle mass, losing fat and increasing bone density. Further, as the glucose is being metabolized rapidly, through the aerobic metabolism pathway, there is reduced chance for fat production. Further, Shafiee et al., (2017) has supported the fact by highlighting that increase in muscle mass and bone density helps people with diabetes to manage their health issue in a more effective way, as muscle use sugars in a better way than fat. Therefore, it is ensuring that there is a less chance for increased glucose concentration in blood.  In addition, a recent study has also highlighted that aerobic exercise is helping to lower HbA1Clevel among type 2 diabetes patients.

3.4 Resistance Training

Bouazizet al., (2016) highlighted that resistance training is the form of exercisethat causes  muscles to contract against an external resistance, which in turn helps to increasemuscle strength, tone, mass and enduranceability. This form of training works through creating microscopic damage or tears to the muscle cells. Upon encountering these damages, body’s repair system promotes muscle regeneration, making the muscle stronger. Upon resistance training, testosterone, insulin – like growth factors, growth hormone, nutrients and proteins rush to the muscle tissue to assist and enable repairs present and ultimately increase strength of tissue. Inder et al.,(2016) highlighted that through this form of consistent training, muscletissues heal and growin a state of res, (while not working out). This highlights the need for leaving time within a workout sessionfor a period of rest, so that therecovery processmay take place. Several types of strength training exercises are performed, including “free weight lifting, weight machines, resistance bands and own body weight”.

3.5 Benefits of resistance training

The benefits of resistance training are well documented. It is noteworthy to mention that with age, atrophy to muscle tissues occurs and the number of muscle fibres present in bones body reduces. It has been estimated by Churchward-Venne et al., (2015) that within age 30 to 70 years, one can lose more than 25% of his type 2 muscle fibres in the body, which are the fast twitch strength fibres. Through resistance exercises and the build up of muscle mass and strengthening of tissues, this form of training could even reverse the aging process and prevent further atrophy of muscle mass, thereby increasing functional capacities. Some evidences have also supported its role in helping to lower blood pressure, increased uptake of calcium in bones, and also increasing bone density. Both strengthening muscle and increasing muscle mass is definitely advantageous beneficial for the older adults, who have high risk of fall and fractures due to frailty. It is also noteworthy that with increased functionality of muscles, resistance training is also able to improve the metabolic rate of the trainee. Therefore, this form of exercise is highly recommended for individuals who are obese or overweight. In a study by Bouaziz et al., (2016) it has been revealed that older adults, having a mean age of 87 years, were subjected to weight lifting schedule for 10 weeks, three times per week. The results highlighted that the strength increased by 113%. It also highlighted that the elderly trainees were able to walk 12% faster than before and able to climb 28% more stairs (Weil, 2019). The measurement of thigh muscle was also increased by 2.5%. In addition, studies have also found significant benefits for mental health issues such as stress, anxiety by resistance training.

3.6 Impact of aerobic exercise on muscle strength and physical performance of older adults

From the studies found, it has been revealed that aerobic exercise is not only improving the physical performance of the older adults, rather these are also enabling the older adults to improve their brain functioning. Although there are a lot of studies available on the improvement of the cardiovascular health of the older adults, Bakken et al., (2001) emphasized upon how it is actually improving physical performance of them, with a key emphasize upon the motor function. In this regards, the authors included 15 elderly patients, whose motor functioning would be tracked. The test group was subjected to “exercise 3 times a week for 8 consecutive weeks”, which included “calisthenics” and “aerobic exercise” like walking and bicycling. In order to measure the progress, the authors relied upon “finger-movement tracking test and submaximal graded exercise tolerance step tests”. The results revealed that aerobic exercise regimen has significant impact upon the motor functioning of the older adults, as the results found noteworthy improvement in finger – movement performance of the test group in the study.

As discussed above, for the older adults, sarcopenia is a common issue, which causes reduction of muscle mass through the procedure. However, it is also noteworthy that there is no strong therapeutic intervention for sarcopenia, which could halt or eliminate the cause of muscle mass reduction. In this context, Bowen et al., (2015) claimed that these conditions, which are categorized as MSD, could be significantly improved by the exercise training. The author in his study claimed that aerobic exercise could attenuate or reverse the muscle wasting process, through the “anti-inflammatory and anti-oxidative effects”, which further attenuates the “signalling pathway” related to the protein degeneration, while activating the molecules related to new protein synthesis. The author, in the review, has highlighted that a recent study, involving 12 weeks aerobic exercise, for 75 years old adults found significant impact of the exercise regiment upon the muscle mass. For instance, they found increased “quadriceps muscle volume”, along with increased “fibre cross – sectional area”. Similarly, another study by the similar author supported the fact by finding that aerobic exercise can reduce the skeletal muscle wasting among the heart failure patients. As the “loss of heart muscle” is highly related with the survival of HF patients, aerobic training could be a significant therapeutic target for these patients. It is evident as they found that aerobic exercise increased “anti-inflammatory and anti-oxidative effect” and increased activity of “GPX and catalase”. Further, reduced “MuRF-1 levels following exercise (4–12 weeks)” has been observed to be linked with increased “thigh muscle cross sectional area”, while compared to older people undergoing sedentary lifestyle.

Another study by Harber et al., (2009) was conducted on the seven older women, 71 years old on average. The study mainly analyzed the muscle function and size, upon subjecting them on a 12 weeks “ergometer training”. The results found that the “aerobic capacity of the subjects” was increased, along with greater “Quadriceps muscle volume”, which was measured through MRI, along with the increase of “knee extensor power”. In addition, results also found reduced “myofibrillar protein concentration”, as a result of the aerobic training. At the end, the authors concluded that the aerobic exercise training is improving the “muscle functioning” of the older adults, through “remodelling of the contractile properties at the myofiber level”, along with significant “muscle hypertrophy”. It is indicating that the “aerobic exercise” needs to be considered as a viral modality for dealing with sacorpenia among older adults.

A very recent study by Bouaziz et al., (2019) conducted a study on understanding the impact of “Interval aerobic training programme with active recovery bout” on the elderly patients. The primary study included seniors within 60 to 70 years old. Several measurement procedures have been used to assess the outcomes including “Trail Making Test”, “Paced Auditory Serial Addition Test”, “Timed Up and Go”, “6-Minute Walk Test”, “one-leg balance test” and “Short Physical Performance Battery test”. The researchers revealed that “semantic fluency, functional performance, one leg balance, mental health and quality of life of the older adults have been significantly improved through the “IATR – P training program”.

Gordon et al., (2013) carried the study to assess the impact of “aerobic exercise”, especially walking training on improvement of functional status and QoL of older chronic stroke survivors. The participants were subjected in 12 weeks program, including 30 minutes ground walk, 3 times per week. The outcomes were measured through “6-minute walk test”, “Motricity Index”, “36-Item Short Form Health Survey” and “Barthel Index” were used. The results revealed significant improvement in walking distance, physical components as well as QoL of the stroke survivor subjects.

3.6 Impact of resistance training on muscle strength of older adults

Like the “aerobic exercise”, another crucial exercise regimen includes the “resistance training”. In this context, maintaining and improving muscle strength is crucial for the older adults to ensure their mobility and improved daily functioning. In this regards, Beijersbergen et al., (2013) conducted a systematic review for understanding how the strength and power training is actually improving walking speed of older adults. The secondary analysis of twenty articles found that among 815 participants, aged 72 years, the associated of “f r2 = 0.21 between the 22% and 12% increase” in “quadriceps strength and gait velocity” respectively. Further, some other studies revealed the association of “r2 = 0.16” within “19% and 9% gains in plantarflexion strength and gait speed” among 75 years old participant group. They concluded that there is a need for shifting the “paradigm” from the “traditional outcomes assessment” to “more sophisticated biomechanical analysis”. This would enable to measure “joint kinematics, kinetics, energetics, muscle-tendon function, and musculoskeletal modelling” for assessing the improvement in walking speed and balance.

Figure: Mechanical plasticity of older adult’s gait

(Source: Granacher et al.,2012)

A recent study revealed that besides the aerobic exercise, resistance training is also able to attenuate the muscle loss related to age, i.e. sarcopenia, among both older men and women. However, it has also been highlighted that the advantages of the exercise regimen is limited once an individual progresses above 80 years. Granacher et al., (2012) further elaborated on the impact of strength training on differed muscle strength related aspects. The author analyzed the “core instability strength training” and its impact. 32 older people were subjected to “9 week progressive CIT” and control. The “isometric strength” measurement was taken for “trunk flexors/extensors/lateral flexors (right, left)/rotators (right, left)” and “spinal mobility in the sagittal and the coronal plane”. In addition, the authors also tested the “dynamic balance and optoelectric walkway”. In this regards, it was revealed that “maximal isometric strength of the trunk flexors, extensors, lateral flexors and left rotators” favoured for the intervention group. On the other hand, “functional mobility in sagittal and coronal plan” also showed favoured position for the intervention group. Therefore, the article proved significant positive impact of CIT training for improving age related muscular deficit.

Table: Outcomes measures for CIT training on older adults

(Source: Granacher et al., 2012)

In support to the previous studies, Chiu et al., (2018) conducted a study in long – term care facility to measure the functional capability of older adults residing in hospital. Here, the researchers included residents more than 60 years age in long term care living sedentary life style were subjected to 12 weeks “muscle strength training program”. The key outcome measures related to the physical parameters included “strength of grip and pinch, and a functional independence”. It has been found from the study indicated difference in “grip and pinch strength” among the intervention and control groups. In this regards, it is noteworthy that there was 1.71 Kg increase in right grip and 1.35 kg in left grip strength, compared to controls. In addition, the intervention group was also found with improved self – care scope by 2.76 point from the control group.

Table: Effects of strength training program on grip strength of older adults

(Source: Chiu et al., 2018)

Another study conducted by Martins et al., (2015) showed contradictory outcome than the previous studies, on muscle strengthening of the older adults through resistance training. Here, the researchers subjected 40 older adults in control and “elastic resistance training” group. The primary outcome measures included “upper and lower limbs muscle mass”, which was done by “Dual-energy x-ray absorptiometry”. In addition, the secondary outcome measures were “knee isokinetic peak torque (PT) at 60°/s and 120°/s speeds and isometric handgrip strength”. The findings revealed change in upper and lower limb fat free muscle mass. However, the secondary outcomes were insignificant. Comparing the outcomes with the previous studies, it can be interpreted that there is a need for minimum 12 weeks session of exercise training, in order to record the differences. As the current study was short term, the outcomes are not significant.

Further, a recent study by Mori and Tokuda (2017) conducted on elderly women supported the above findings. Here, the subjects were included in the “12 week weight-bearing and resistance band exercises” for 3 times a week. The study was unique, as it combined the physical exercise regimen with a protein intake schedule, to analyze the combined impact. “Multi-frequency bioelectrical impedance analysis” was used for measuring the body weight and physical composition”. The results revealed that in terms of physical performance, the exercise regimen interfere with muscle mass and strength reduction. On the other hand, when the regimen was combined with protein intake, it showed increase in “muscle mass, walking speed and knee extensor strength”. Specific to women, this study helped to understand that the combination of light to moderate strength training with nutritional balance could improve muscle strength and physical performance.

Table: “Comparison of limb muscle mass and physical functions pre-/post-intervention”

(Source: Mori and Tokuda, 2017)

3.7 Impact of combined regimen of physical exercises on older adults

Besides the individual benefits of aerobic exercise and resistance training regiment on the performance and muscle strength of the older adults, there are several studies, which has revealed that the combined effect of these two regimens is more effective than the single one. In this regards, it is also noteworthy that some studies have also argued that one particular regimen is more effective in mitigating a particular issue of the older adults. Villareal et al., (2017) conducted the study to find out whether the combination works better for the obese older adults. The results found that the “physical performance test score” was higher for the group, who were subjected to the combination of “aerobic and resistance training exercise schedule”. The combination group and resistance training group revealed increased muscle strength than the aerobic group. On the other hand, aerobic group has shown increased lean mass loss than combination and resistance training group. Overall, the study concluded improved physical performance benefits for combination regimen than a single intervention.

Another study by Tan et al., (2012) performed a “6-month combined aerobic and resistance training program” including the older adults with chronic type 2 diabetes. The regimen involved “a warm-up period”, “30 minutes of moderate aerobic exercise”, “10 minutes of resistance training” with “five leg muscle exercises” (“two sets of 10-12 repetitions at 50-70% of 1RM for each activity”) and “a cool-down period”. The findings revealed that the regimen is suitable for reducing “waist-hip ratio and body fat”, while showing a significant control on blood glucose level. In regards to the physical strength of the older subjects in the study, it has been revealed that the subjects improved their “leg muscle strengths”, along with the measure of walking distance by 6 minutes, compared to the control group. In addition, the other physiological outcome measures were also seen to be changed for the diabetic older subjects by the “combined regimen of aerobic and resistance training”.    

Table: Effect of six month combined exercise regimen on the patients

(Source: Tan et al., 2012)

With specific focus on gait speed, Henderson et al., (2017) conducted a study by subjecting obese and overweight older adults, undergoing sedentary lifestyle into a 5 month resistance training and aerobic exercise regimen. Participants were subjected randomly to “4 days/weeks moderate-intensity treadmill walking” or “3 days/weeks moderate-intensity RT”. The outcome measurements included “usual-pace gait speed, fast-pace gait speed and short physical performance battery (SPPB)”. Specifically “VO2peak for aerobic” and “knee extensor strength for resistance training” were measured respectively. The findings revealed that both the regimens successfully improved the “usual pace gait speed and SPPB”. On contrary, aerobic exercise improved “fast gait speed”, resistance training showed less “usual-pace gait speed” improvement, as it is associated with “lower baseline knee strength”.

Table: Effect of AT and RT on gait speed of older adults

(Source: Henderson et al., 2017)

Similarly, Holviala et al., (2011) conducted a study, including the older adults in 21 week “strength, endurance and combined training” for “neuromuscular, endurance and walking performances as well as balance” improvement. This study was focused on older men only. It has been revealed from the findings that  the strength training and combined SET showed significant improvement in “explosive strength, walking speed and balance”. However, only enduring training did not showed significant improvement on the muscle strength and physical performance.

Another multicomponent exercise regimen was experimented by Cardore et al., (2014), which included “muscle power training” (“8–10 repetitions, 40–60 % of the one-repetition maximum”) along with “balance and gait retraining” of the older adults, who have been identified with the risk of sarcopenia and frequent fall. The upper and lower limb strength and power test, “ime-up-and-go test” gait velocity and dual task performance were measured. The outcomes showed significant improvement in TUG, balance performance, chair resistance, while showing significant less risk of fall. In addition, the intervention group was also seen to consist increased density of “muscle cross sectional area”, compared to control group. All the findings are indicating that there is significant improvement of physical performance and muscle strength upon the combined exercise training.

Figure: TUG test and Chair resistance test on older adults

(Source: Cardore et al., 2014)

3.8 Preferred aerobic exercise and resistance training regimen for older adults

There are a range of physical exercise regimens, which were found to be beneficial for the older adults, to improve their muscle strength as well as overall functionability. Taylor (2013) highlighted the most preferred aerobic exercise and resistance training for older adults. In this regards, it is noteworthy that the feasibility and success of the aerobic exercise and resistance training programs varied according to the demographic and health status of the selected population of older adults. However, it is also noteworthy that some studies have highlighted the standard exercise regimen, from which the older adults have gained significant benefits over time. In this regards, it is noteworthy from the existing literatures that aerobic exercise, which have been found to achieve most success in terms of older adults’ physical performance and functionality, are “brisk walking, swimming and dancing”. Supporting the findings, Merom et al., (2013) claimed the association of dance regimen with significant improvement of the balance and reduction of fall incidents among the older adults.

In a RCT study, as balance training under the aerobic workout regiment, 450 participants were subjected to the social dancing regimen. In this context, it is noteworthy that the study concluded it as a novel approach of balance training for the older adults. It is a community based approach, which has shown significant improvement in fall risk, while offering the opportunity for social engagement of the participants. According to the WHO guidelines, highlighted by Taylor (2013), “aerobic exercise regimen” must be of moderate level, instead of including the vigorous level of activity, which would include heart and breathing rate. On contrary, resistance training included regimen for enhancing muscle strength. The most frequently used protocols include “high intensity strength training” for the older adults; however, the protocol is set based on the purpose. The author highlighted that the most frequently used protocol includes “8 to 12 repetitions”. These vigorous protocols include continuous support from the “exercise professionals”, with special arrangements. Supporting this findings, another study by Tan et al., (2012) revealed significant success on a 6 month combined regimen, which included “a warm-up period”, “30 minutes of moderate aerobic exercise”, “10 minutes of resistance training” with “five leg muscle exercises” (“two sets of 10-12 repetitions at 50-70% of 1RM for each activity”) and “a cool-down period”. Therefore, it can be considered as a standard protocol for the older adults. 

Another national level study conducted by Bann et al., i.e. “LIFE study” revealed that light intensity physical activities are showing significant benefits on improving the quality of life of the older adults. For instance, the cross sectional study revealed significant association within the lower BMI and light intensity activities, which in turn showed associated with improved quality of life. The activity type included gardening, kitchen work, cycling, swimming, brisk walking. The study also found benefits of these activities on the disability and mobility status of the older adults having musculoskeletal disorders.

3.9 Importance of exercise regimen for older adults

Several primary and secondary studies have highlighted that physical exercise are significantly important for improving the quality of life and enhancing their health benefits. In this regards, it is noteworthy that Arguirre et al., (2015) discussed that reduced physical activity associated with aging is in turn decreasing the exercise capacity of older adults, while enhancing the risk of frailty. Further, the author argued that “frailty” is related to “poor exercise tolerance and reduction of muscle mass”. According to the findings, “aerobic endurance training” has significant positive impact upon increasing the peak oxygen consumption by approximately 10 to 15%. In this regards, resistance training has been highlighted as the best way to improve muscle mass and strength. Besides these interventions alone, several studies have identified that the exercise regimens, combining aerobic exercise and resistance training have gained maximum outcomes for the older adults.  Besides attenuating frailty, the combined intervention significantly improves muscle strength of the older adults. Supporting this, () identified that resistance training enhanced muscle mass of healthy older people by 16 to 23% and 2 to 9% among frail adults. On the other hand, a “9 month walking and strength training program at 78% of peak heart rate” resulted in enhanced “endurance” with the improvement of 14% VO2peak. A similar study by Villareal et al., (2011) revealed “10% increase of VO2peak” upon “12 month” similar program with “107 frail obese older people”. This study also found clinically significant weight control among this obsese population, which also improved their physical performance, which were measured through improved walking speed. The disability in walking of this group was assessed by their improved capacity of completing 400 meter walk.

Figure: Theoretical framework of the role of physical exercise against frailty among older adults

(Source: Aguiree and Villareal, 2015)

Further, the above findings have been supported by Taylor (2013), as he argued that “physical activity is a medicine for the older adults”. The author revealed that throughout the world, approximately 3.2 million people die, which is associated with inactivity. The increased risk of frailty and co-morbidities are being highlighted as a result of sedentary and inactive lifestyle of the older adults. Thus, exercise is working as a medicine for the older adults. This study was supported by Harber et al., (2015), which revealed that “aerobic training alone” and combined with “resistance training” are improving the functional independence of the older adults, which is indicated by “muscle strength” and “aerobic fitness”.

3.10 Impact on NHS

Exercise referral scheme may offer various benefits to the inactive and sedentary people among the clinical population. According to Rowley et al. (2018), older adults should try to be active in their daily lives and they should do moderate activities. This will help to reduce the costs of health services like costs of hospitals, lack of physical activity leads people to hospital stay a year at the cost of £3215. Practising physical activity will reduce the costs of NHS by reducing the rate of hospital stays. Moreover, it will help NHS to show the decreased morbidity and mortality rate by improving the quality of life

Chapter 4: Discussion and Conclusion

4.1 Discussion

The current study was conducted, with a key focus upon analyzing and investigating the impact of two known exercise types, i.e. aerobic exercise ad resistance training on the physical performance and muscle strength of the older adults. It has been revealed from the existing studies that both the aerobic exercise and resistance training has significant positive impact upon the physical performance and muscle strengthening. With age, muscle strengths become poorer and people starts loosing muscle mass, which leads to sarcopenia and frailty. Several age-related factors are promoting these changes. Although exact pathway has not been defined well, but it has been revealed that the “aerobic exercise and resistance training regimens” are able to attenuate sarcopenia and improve the muscle strength further. Most of the studies have highlighted that for older adults, light to moderate strength training and aerobic exercise are preferable for improving the muscle strength, balance and overall physical performance, including grip, walking and climbing speed” (Beijersbergen et al., 2013).

In this regards, one crucial aspect Harber et al., (2018) have highlighted, which is the role of these exercise regimens, upon the musculoskeletal disease like osteoporosis. The author found significant benefits over these exercise schedules. Supporting the findings, the current study revealed that the exercise regimens are helping attenuate frailty, reduce fall risk, improved quality of life, helps to reduce hypertension and improves the overall physical function and quality of life of the older stroke survival people. These exercise regimens has also shown important contribution in weight loss and lifestyle management of obesity and type 2 diabetes patients. Further, several existing studies have also found that the “aerobic exercise” is playing a crucial role in improving the brain structure, which in turns promote improved functioning of the musculoskeletal system, while sowing significant benefits on cognitive functioning also. Several studies have found improved gait balance, which supported the findings of the current literature review.

Improved grip, pinch and increased muscle mass have also been found, indicating significant benefits over muscle functioning. Further, the study has also revealed that instead of implementing alone, while being implemented in combination, these exercises have shown improved outcomes (Cadore et al., 2014). However, in some specific cases, single regimen has been found to work better. For instance, the “aerobic exercise” has been seen to improve overall balance, walking speed and independence of the older adults. On the other hand, the resistance training has shown significant increase in muscle mass, gait balance and improves muscle strengths.   

Instead of possessing several strengths, the study has some limitations. For instance, it has only included the secondary data. For limited time, only 20 articles have been reviewed. Although the results showed significant authentication, but small sample size is a key drawback of the study, which indicates that the findings may not be suitable for wider implications.

4.2 Conclusion

Overall, from the findings and discussion, it has been revealed that the alternative hypothesis of the study has been established, i.e. “there is a significant positive impact of aerobic exercise and resistance training on physical performance and muscle strength of the older adults”. The findings have supported the existing literatures, indicating significant benefits of these exercises for the older adults’ age related issues. It is also concluded that combination of these two exercises is offering an improved results, compared to a single regimen.

4.3 Recommendations

Improvement via improving daily lifestyle:

As with age, body fat increases and the muscle mass reduces, it is necessary to develop the skeletal muscle mass and decrease the body fat with overall body fat percentage. With age, the daily life style of people changes. People became weaker and the activity level became decreased. It is necessary to develop. With age, people need to be aware about their everyday lifestyle. They should a healthy lifestyle pattern; it is necessary to choose healthy eating pattern with healthy and moderate exercise. These type activities do not create pressure on the muscles of the older adults but it reduces the mortality rate and improves the quality of life.

Improvement via diet modification:

Diet plays vital role in case of being healthy. With age, it is necessary to develop the dietary pattern. The diet of older adults need to include right proportion of carbohydrate, fat, protein, minerals, vitamins and should be rich with dietary fibres. The dietary fibres help to develop the bowel motion of them as with age problems of constipation are seen. Health and nutrition has a strong connection that influences the physical performance of the older adults. The older adults need to take moderate to low protein with high dietary fibre rich foods as well as the amount of carbohydrate also should be low. They need to take foods that are rich with vitamins also, which will help to develop the physical performance and reduce the health issues related to diet and nutrition deficiency. 

Improvement via free hand exercise and walking:

In case of older adults, walking and free hand moderate exercise play significant role to maintain the physical activity level. Aerobic and physical strengthening exercises can harm the muscle and body of the older adults. Walking of 60 minutes every day helps to burn 1.6 to 2.4 calories for every pound of body weight that depends on speed. At the average walking pace, one can burn 250 to 350 calories per day. On the other hand, the older adults can burn more calories by practicing free hand exercises; for examples, push-ups, sprinting, stretching and lying leg curls.

4.5 Future scope of research

The above study findings can be used as a primary base for several studies in the related field. For instance, the findings could be used as the support material for the research focusing upon the strength training or aerobic exercise and combination of these training with dietary supplements for assessing the health improvements of the older adults.

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