Self Sufficient Movement in Elderly/Impaired

As I became more educated in the field of kinesiology, I noticed more and more changes that occurred in my grandmother back in Germany. As she grew older, she needed more and more accessory muscle groups to help her raise herself off the couch, out of a chair, or getting out of a car. Her gait was a shuffle seemingly moving more side to side than forward as she struggled for stability before finally needing a cane to aid in her movement from one point to another. It wasn’t especially sad, because it is what we’ve been told is the natural progression of aging, but what if that progression does not have to be as deleterious as we imagine it to be? In this article, we will discuss self-sufficiency in movement by two operational definitions, the importance of self-sufficiency, and what could be done to make self-sufficiency a life-long reality – if you struggle rising from a chair or struggle walking, this is the article for you.

What is Self-Sufficient Movement?

Self-sufficient movement can be defined by a variety of methods, but we will look at two aspects that are at the very core of being able to move independent (or with greater independence) from assistance devices/people; those two methods are Sit to Stand (STS) and gait speed. Sit to Stand is, typically, defined as the ability to go from a seated position to a standing position without the use of the arms or any other outside assistance other than your legs planted on the floor; however, some definitions include the use of the arms [1]. On the other hand, gait speed is the speed/velocity of movement forward, and in this case – walking measured, typically, in a tandem 6 meter test [2].

Importance of Self-Sufficient Movement?

This is where the take home message should be and is often misunderstood by younger, healthier populations. As we age, our ability to be self-sufficient slowly declines and is mostly due to, not a variety of health reasons, but sarcopenia (aka, the loss of muscle due to age/time); this is due to the fact that people lose between 3-8% of their muscle mass per decade of life after age 30, with 1-2% loss in muscle mass in the legs per year after age 50, and 1.5 – 5.0% strength loss per year after age 50 [3][4][10]. The severity of the issue becomes clear when we realize that muscle, and strength from that muscle, are the reasons why we can stand and move in the first place, so a significant drop in that tissue should leave us unsurprised that standing and walking become harder and harder to do independently. Not only that, the type of muscle lost being more type II, fast twitch (aka, “explosive”, needed to move upward and downward) than type I, slow twitch (aka, “endurance”) [10]. Finally, a lack of balance and overall weakness can lead to a fall which can, in its own right, lead to serious breaks, damage, and in some cases, immobility to death [11].

More precisely, if we examine muscle contraction from sit to stand along various ages, we see a linear decline [5]. At ages 20, 30, and even early 40s, submaximal levels of muscle contraction/recruitment are necessary to perform a typical, day to day, sit to stand; however, once the late 40s and early 50s roll around, maximal recruitment is necessary to accomplish the same movement of simply standing up [5]. Then, around ages 70 and above, even maximal muscle recruitment is not sufficient to go from a sitting position to standing without assistance – meaning, the use of the arms and other assistances are necessary [5].

Now, in terms of gait (walk) speed, there is also an incredibly noticeable decline which shows in the speed a person can move forward [6][7]. This means that people, likely, have a decreased stability and/or force production through the muscles. Gait speed, in particular, is an all-around used test to determine mortality risk, because the slower the walk speed, the higher the mortality risk in the elderly [8][9].

This diagram shows the level of leg muscular recruitment needed to go from a seated to standing position (in yellow box) and how that strength decreases over time.

So, all in all, the ability for the elderly to move without assistance, get on and off the toilet, and decrease the likelihood of falls are major players in needing/wanting to be self-sufficient.

How to gain greater Self-Sufficiency in Movement?

Now, while we now understand what big three issues plague those who are physically impaired and/or elderly, this article would be a cruel reminder of age’s grasp if we did not go over preventative measures to reassert independence and functional health.

Many might believe that it is simply too late to begin doing serious intervention to improve one’s independence, and those people are simply dead wrong. Even at ages of 90 years and more, strength training done for more than 8 weeks, 2-3 times a week, at manageable, but strenuous intensity (50-80% of maximum weight) lead to incredibly significant muscular growth (9% increase in muscle size) and return of strength (nearly tripled from pre-lifting) completely independent of nutrition (which would compound this rebound effect if controlled for with caloric surplus, protein recommendations met, and micronutrients at RDA) [6]. The stronger you are, the faster your gait speed, as a result; and, a faster gait speed is associated with lowered mortality risk [6][7][8][9]. Not only that, strength training seems to point, according to most studies, to a faster, more powerful sit to stand velocity [12][13].

On the other hand, balance is not helped by strength training and strength training, therefor, may not help in prevention of falls. However, balance exercises and techniques do have a significant impact on balance, even at ages 80 and more [14][15]. So, a mix of strength training and balance exercises show significant improvement in elderly 65+ in all three concerns: sit to stand, gait speed, and balance for fall prevention.

Practical Recommendations?

For people who want to ease into the process, it might be recommended to begin balance exercises 2-3 times a week, compound strength training 2 times a week at 50% intensity (determined based off a “max calculator”), or even using just bodyweight.

For people who are eager to jump into the process, it might be recommended to begin balance exercises 4-5 times a week, compound strength training, with weights, 3 times a week at 50 – 60% intensity (determined based off a “max calculator” or supervised maximum test) and progressively increase intensity slowly.  

SUMMARY

In summary, self-sufficient movement is the ability to sit up and sit down from a seated position without assistance; as well as, being able to walk without assistance. These concepts are important, because as we age, muscle loss, and consequently, strength loss decline; this leads to a decreased mobility in terms of walking, standing up, and even balance to keep from falling. These are key parts of elderly and/or impaired living that need to be addressed every day and we discussed a few ways those issues can be addressed. First, implementing strength training has profound rehabilitation and prevention effects on the body, even in people 80 and 90 or older, as strength training attenuates and reverses degradation in the ability to walk and stand up from seated positions. Secondly, implementing balancing exercises several times a week leads to noticeable increase in coordination and balance, which decrements therein are driving causes of bad falls leading to serious injury among the elderly. So, these two methods in combination can have massive, noticeable, life changing benefits that may keep you or your loved ones out of rehabilitation centers, nursing homes, and other assisted living quarters.

Writer: Nicolas Verhoeven
Citations

[1] Etnyre, B., & Thomas, D. Q. (2007). Event Standardization of Sit-to-Stand Movements. Physical Therapy, 87(12), 1651-1666. doi:10.2522/ptj.20060378

[2] Peel, N. M., Kuys, S. S., & Klein, K. (2012). Gait Speed as a Measure in Geriatric Assessment in Clinical Settings: A Systematic Review. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 68(1), 39-46. doi:10.1093/gerona/gls174

[3] English, K. L., & Paddon-Jones, D. (2010). Protecting muscle mass and function in older adults during bed rest. Current Opinion in Clinical Nutrition and Metabolic Care, 13(1), 34-39. doi:10.1097/mco.0b013e328333aa66

[4] Keller, K. (2014). Strength and muscle mass loss with aging process. Age and strength loss. Muscles Ligaments Tendons Journal, 3(4), 346-350. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3940510/

[5] Kenney, W. L., Wilmore, J. H., Costill, D. L., & Wilmore, J. H. (2012). Physiology of sport and exercise. Champaign, IL: Human Kinetics.

[6] Fiatarone, M. A. (1990). High-Intensity Strength Training in Nonagenarians. JAMA, 263(22), 3029. doi:10.1001/jama.1990.03440220053029

[7] Schlicht, J., Camaione, D. N., & Owen, S. V. (2001). Effect of Intense Strength Training on Standing Balance, Walking Speed, and Sit-to-Stand Performance in Older Adults. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56(5), M281-M286. doi:10.1093/gerona/56.5.m281

[8] Cesari, M. (2011). Role of Gait Speed in the Assessment of Older Patients. JAMA, 305(1), 93. doi:10.1001/jama.2010.1970

[9] Peel, N. M., Kuys, S. S., & Klein, K. (2012). Gait Speed as a Measure in Geriatric Assessment in Clinical Settings: A Systematic Review. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 68(1), 39-46. doi:10.1093/gerona/gls174

[10] Vella, C. (n.d.). Sarcopenia. Retrieved from https://www.unm.edu/~lkravitz/Article%20folder/sarcopenia.html

[11] Important Facts about Falls | Home and Recreational Safety | CDC Injury Center. (2016). Retrieved from Center of Disease Control website: http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html

[12]
Schot, P. K., Knutzen, K. M., Poole, S. M., & Mrotek, L. A. (2003). Sit-to-Stand Performance of Older Adults following Strength Training. Research Quarterly for Exercise and Sport,74(1), 1-8. doi:10.1080/02701367.2003.10609058

[13] Bohannon, R. W. (2010). Sit-to-stand test: Performance and determinants across the age-span. Isokinetic Exercise Science, 18(4), 235-240. doi:10.3233/IES-2010-0389

[14] Wolfson, L., Whipple, R., Derby, C., Judge, J., King, M., Amerman, P., … Smyers, D. (1996). Balance and Strength Training in Older Adults: Intervention Gains and Tai Chi Maintenance. Journal of the American Geriatrics Society, 44(5), 498-506. doi:10.1111/j.1532-5415.1996.tb01433.x

[15] Bulat, T. (2007). Effect of a group-based exercise program on balance in elderly. Clinical Intervention Aging, 2(4), 655-660. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2686325/



 

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