Anthony A. Vandervoort

Aging of the human neuromuscular system

Loss of cells from the motor system occurs during the normal aging process, leading to reduction in the complement of motor neurons and muscle fibers. The latter age‐related decrease in muscle mass has been termed “sarcopenia” and is often combined with the detrimental effects of a sedentary lifestyle in older adults, leading to a significant reduction in reserve capacity of the neuromuscular system, which is the primary subject of this review. Clear evidence of this aging effect is seen when voluntary or stimulated muscle strength is compared across the adult lifespan, with a steady decline of ∼1–2% per year occurring after the sixth decade. Interestingly, when compared with isometric contractions, the effect of aging is more pronounced for concentric movements and less for eccentric movements (i.e., muscle shortening versus lengthening). This phenomenon appears to be linked to the stiffer muscle structures and prolonged myosin crossbridge cycles of aged muscles. It is encouraging that the capability of physiological adaptations in the motor pathways remains into very old age — when an appropriate exercise stimulus is given — and long‐term prevention strategies are advocated to avoid excessive physical impairments and activity restrictions in this age group.

Aging of human muscle: structure, function and adaptability

With increasing age, human skeletal muscles gradually decrease in volume, mainly due to a reduced number of motor units and muscle fibers, and a reduced size of type 2 fibers. As a result, progressive weakening and impaired mobility occur. High‐resistance strength training is beneficial, even in the very old, and could possibly reverse some of the detrimental effects of age‐related weakness. The importance of exercise for older people affords an excellent opportunity for the medicine community as a major source of information and promotion of physical activity for this rapidly growing segment of the population. In this review, we summarize the current knowledge of the effects of aging on the human neuromuscular system, describe some of the major underlying mechanisms of the aging atrophy and focus on the importance of strength training to improve muscle function in older people.

Age-related changes in motor unit function

This review focuses on the functional relationship between age‐related morphological and physiological changes at the level of the motor unit (MU). It is well established that older humans are weaker than younger people, exhibit reduced force control, and have slower neuromuscular contractile properties. Older people may also exhibit a decrease in MU discharge rate, and an increase in variability of MU discharge at high force levels. The matching of MU discharge and contractile properties may be an age‐related neurophysiological strategy adopted to optimize motor control, similar to that observed in acute conditions such as fatigue. Because muscle force output is modulated partially by MU discharge behavior, the study of these properties may offer insights into the physiology of muscular weakness and motor function in older people. In turn, this will allow the implementation of optimal exercise and rehabilitation programs to reduce the degree of dependence associated with aging.

The effectiveness of exercise interventions for the management of frailty: a systematic review.

This systematic review examines the effectiveness of current exercise interventions for the management of frailty. Eight electronic databases were searched for randomized controlled trials that identified their participants as “frail” either in the title, abstract, and/or text and included exercise as an independent component of the intervention. Three of the 47 included studies utilized a validated definition of frailty to categorize participants. Emerging evidence suggests that exercise has a positive impact on some physical determinants and on all functional ability outcomes reported in this systematic review. Exercise programs that optimize the health of frail older adults seem to be different from those recommended for healthy older adults. There was a paucity of evidence to characterize the most beneficial exercise program for this population. However, multicomponent training interventions, of long duration (≥5 months), performed three times per week, for 30–45 minutes per session, generally had superior outcomes than other exercise programs. In conclusion, structured exercise training seems to have a positive impact on frail older adults and may be used for the management of frailty.

Quadriceps muscle strength, contractile properties, and motor unit firing rates in young and old men

Changes with age in the voluntary static and dynamic strength of the quadriceps muscle group have been well characterized, and the importance of the muscle group for locomotion and independent living have been highlighted in both normal human aging and in clinical studies. Surprisingly few studies of this muscle group have described age‐related changes in voluntary activation ability using twitch interpolation and changes in stimulated contractile properties, and none have assessed the influence of old age on motor unit firing rates. We compared in 13 young (mean age 26 years) and 12 old (mean age 80 years) men the voluntary isometric strength, stimulated contractile properties, and average steady state motor unit firing rates in the quadriceps muscle. Maximum voluntary contraction (MVC) force and twitch tension were ∼50% lower in the old men, but contractile speed was only ∼10% slower than in the young men. There was no difference in the ability of either group to activate the quadriceps to a high degree (94–96%). At all isometric force levels tested (10%, 25%, 50%, 75%, and 100% MVC), there were no differences in mean motor unit firing rates. In both groups, the range of firing rates was similar and not large (∼8 Hz at 10% MVC and 26 Hz at MVC). Thus, the substantial age‐related weakness in this muscle does not seem to be related to changes in neural drive.

Lateral trunk lean explains variation in dynamic knee joint load in patients with medial compartment knee osteoarthritis

OBJECTIVE To test the hypothesis that selected gait kinematics, particularly lateral trunk lean, observed in patients with medial compartment knee osteoarthritis explain variation in dynamic knee joint load. METHOD In this cross-sectional observational study, 120 patients with radiographically confirmed varus gonarthrosis underwent three-dimensional gait analysis at their typical walking speed. We used sequential (hierarchical) linear regression to examine the amount of variance in dynamic knee joint load (external knee adduction moment) explained by static lower limb alignment (mechanical axis angle) and gait kinematics determined a priori based on their proposed effect on knee load (walking speed, toe-out angle, and lateral trunk lean angle). RESULTS Approximately 50% of the variation in the first peak external knee adduction moment was explained by mechanical axis angle (25%), Western Ontario and McMaster Universities Osteoarthritis Index pain score (1%), gait speed (1%), toe-out angle (12%), and lateral trunk lean angle (13%). There was no confounding or interaction with Kellgren and Lawrence grade of severity. CONCLUSIONS Gait kinematics, particularly lateral trunk lean, explain substantial variation in dynamic knee joint load in patients with medial compartment knee osteoarthritis. While largely ignored in previous gait studies, the effect of lateral trunk lean should be considered in future research evaluating risk factors and interventions for progression of knee osteoarthritis.

Motor Unit Number Estimates in Masters Runners: Use It or Lose It?

INTRODUCTION A contributing factor to the loss of muscle mass and strength during aging is the reduction in the number of functioning motor units (MU). It has been shown that lifelong physically active older rats have greater numbers of MU compared with age-matched sedentary controls, suggesting that chronic exercise may preserve MU function with advancing age. This has not previously been examined in humans. PURPOSE Thus, the purpose of this study was to estimate the number of functioning MU in the tibialis anterior of masters runners (approximately 65 yr) and to compare the values with recreationally active young (approximately 25 yr) and healthy age-matched controls (approximately 65 yr). METHODS Decomposition-enhanced spike-triggered averaging was used to collect surface and intramuscular EMG signals during dorsiflexion at 25% of maximum voluntary isometric contraction. RESULTS The estimated number of MU did not differ between masters runners and young, but MU number estimates were lower in the old (91 +/- 22 MU) compared with the masters runners (140 +/- 53 MU) and young (150 +/- 43 MU). CONCLUSION These results demonstrate that lifelong high-intensity physical activity could potentially mitigate the loss of MU associated with aging well into the seventh decade of life.

Plantarflexor muscle function in young and elderly women

SummaryContractile properties of the ankle plantarflexor muscles were compared between groups of young (¯x=26y) and elderly (¯x=82y) women. The H-reflex muscle contraction in the elderly group was characterized by a significant slowing of torque generation, as compared to the young women (means for average rate of torque development were young=0.16 Nm ms−1±0.02 (SE), elderly=0.09 Nm ms−1±0.02,P<0.05). However, the proportion of the total motor unit pool activated by the reflex was similar for the young and elderly groups at 63% and 70%, respectively. Maximal voluntary isometric torques were significantly lower (71%) in the elderly (young ¯x=135.3 Nm±9.3, elderly ¯x=39.2 Nm±2.9,P<0.01). These results are consistent with, and extend, previous reports showing decreased strength and speed of contraction in elderly muscle. Given that the average body weight was similar for the young and elderly groups, it was concluded that the aged plantarflexor muscles exhibited considerable impairment in ability to generate stabilizing torques about the ankle joint.

Knee bracing after ACL reconstruction : effects on postural control and proprioception

PURPOSE To evaluate the effects an anterior cruciate ligament (ACL) brace has on various measures of knee proprioception and postural control. METHODS Thirty subjects (mean age 27 +/- 11 yr) having undergone unilateral ACL reconstruction were tested with and without wearing their own custom-fit brace on their involved limb. Proprioception was assessed using joint angle replication tests completed on an isokinetic dynamometer. Postural control was assessed using a series of single-limb standing balance tests completed on a force platform. The balance tests included: 1) standing on the stable platform with eyes open, 2) standing on a foam mat placed over the platform with eyes open, 3) standing on the platform with eyes closed, and 4) standing on the platform after landing from a maximal single-limb forward hop. RESULTS The brace provided a small but statistically significant improvement in proprioception (mean reduction in error scores between target and reproduced angles = 0.64 +/- 1.4 degrees, P = 0.02). For the postural control tests, there was a significant brace condition by test situation interaction (P = 0.02), with the brace providing a small but statistically significant improvement during the test completed on the stable platform with eyes open (mean reduction in center of pressure path length = 4.2 +/- 8.4 cm, P = 0.02) but not during the other more challenging test situations. Additional post hoc analyses indicated that the relationship between knee proprioception and postural control measures were low and not significant (r = 0.003 to 0.19, P > 0.32), consistent with the suggestion that changes in knee proprioception can occur in the absence of substantial changes in postural control. Also, standing balance tests that challenged the somatosensory contribution to postural control (i.e., those completed on foam, or with eyes closed) were significantly related to single-limb forward hop distances (r = -0.4, P < 0.05), whereas performance during the proprioception test was not (r = 0.1, P > 0.50). CONCLUSIONS In general, bracing appears to improve performance during tasks characterized by relatively limited somatosensory input but not during tasks characterized by increased somatosenory input. The small magnitude of the improvements, coupled with their apparent lack of carry over to more difficult and functionally relevant tasks, questions the clinical benefit of the present effects of bracing.

Effect of a neoprene sleeve on knee joint kinesthesis: influence of different testing procedures.

PURPOSE Objectives of this study were to examine the perceived sense of knee joint position during selected test situations, and to evaluate the proposed kinesthetic effect of a neoprene knee sleeve during these test situations. METHODS Fifty-nine young healthy subjects (39 females and 20 males) attempted to replicate target knee joint angles using active and passive knee extension movements completed in sitting (nonaxially loaded) situations, and during active knee extension movements completed in supine while applying a load of 15% body weight through the long axis of the tibia (axially loaded). The criterion measure used was the absolute difference between target and reproduced angles, averaged over five attempts (Average absolute difference: AAD). RESULTS A three-way ANOVA (two genders by three test situations by two sleeve conditions), with repeated measures on the last two factors, indicated a significant main effect for test situation and sleeve condition (P < 0.05), but not for gender. There was also a significant test situation by sleeve condition interaction (P < 0.05). Post-hoc analysis indicated that the AAD score during the active nonaxially loaded test situation without the sleeve was significantly greater than AAD scores for all other tests (P < 0.01). CONCLUSIONS Pre-existing differences in knee joint kinesthesis observed during different contexts of limb movement must be recognized before various interventions, including the effect of knee supports, can be adequately interpreted. Because knee joint position sense was attenuated during voluntary active movement, and because this attenuation was ameliorated by the use of a sleeve, future studies evaluating the kinesthetic effects of knee bracing may benefit from using active movements. However, since the sleeve did not affect performance during the axially loaded test situation, future studies should also evaluate the relationship between tests of knee joint kinesthesis and other more functional tests of neuromuscular performance.