One of the hallmark features of aging is the loss of muscular mass and strength. Much of this loss can be explained by changes to the neuromuscular system such as decreased number of motor neurons, decreased number of muscle fibers, and decrease muscle fiber size. But it is important to ask whether these changes are a consequence of aging or simply a result of an inactive lifestyle.

Age-Related Changes to Muscle

The age related decline in muscle mass appears to occur in 2 phases. The first or “slow” phase of muscle loss, in which 10% of muscle mass is lost, occurs between the ages of 25 and 50. The majority of muscle loss occurs thereafter where an additional 40% is lost from the ages of 50 to 85. Overall, the human body loses 50% of its muscle mass by the age of 80. This muscle atrophy can be explained by significant decreases in both the total number of muscle fibers, as well as in muscle fiber size.

It has been shown that aging results in a loss of the power and speed producing fast twitch fibers (particularly IIb) and an increase in the more aerobic slow twitch fibers. This seems to make sense since movements that demand a high velocity of contraction (such as jumping and sprinting) tend to be less in the older years.

Mechanisms of Strength Loss

The problems with decreasing strength can be seen in its contribution to osteoporotic decline in bone density, arthritic joint pain, and an overall reduced functional capacity.

With the loss in muscle mass evidently comes a decrease in muscular strength. However, as with muscle loss, most strength losses are not significant until the sixth decade. As briefly mentioned, this loss in strength can be attributed to a decrease in the number of motor units (nerve-muscle fiber complex), the decreased number of muscle fibers and the reduction in muscle fiber size. It is also known that a decline in leg strength precedes upper extremity strength loss in the elderly. This is important due to the fact that strength, rather than cardiovascular function, is considered to be the most physically limiting factor in the elderly. This is apparent when considering strength-limiting activities faced by many seniors such as getting up from a seated position or walking up stairs.

Encouraging is the finding that aging does not seem to effect eccentric strength. This phase of contraction is an important consideration for the elderly due to the possible linkage between poor eccentric strength and the incidence of falls in the elderly.

The Importance of Active Living

Regular exercise is the most effective way to slow and counteract the effects of age-related muscle and strength loss. Comparisons between active and sedentary older adults suggest that much of the strength loss with aging is due lifestyle factors. For example, individuals who continue to use certain muscles on a regular basis do not show the same age-related decreases in strength. In general, muscle atrophy, and thus strength loss, will occur any time the muscles are not required to work against a given load. The result will be a decrease in protein synthesis accompanied by an increase in protein breakdown. Overall, the muscle atrophies and loses much of its strength, characteristics commonly seen in astronauts during space flight. Incorporating regular resistance training is the most effective means of attenuating this effect.


Encouraging Findings

Studies have consistently shown that regular exercise can improve muscular endurance and strength in the elderly in a manner similar to that observed in young people. One of the largest studies in this field was done at McMaster University several years ago. The researchers looked at the effects of 2 years of twice/weekly strength training (80-85% 1RM) across 114 subjects between the ages of 60-80 years. The results indicated steady increases in strength in each of the muscle groups tested with no evidence of plateauing. There were also significant increases in muscle mass accompanying the gains in strength and, perhaps more importantly, there was evidence that these strength gains translated into improved function (as measured by walking and stair climbing performance).

Although there are certain unavoidable changes that occur with aging, it is possible to delay or attenuate the losses muscle mass and strength normally accompanying these changes. Since so many daily living activities such as walking, climbing stairs, and standing up from a chair are so dependent on strength it is imperative to minimize the age-related loss in strength as much as possible. The muscles in older adults maintain their ability to adapt; therefore, regular resistance training (2-3x/week) should be implemented into the lifestyle of such individuals. Moreover, a similar strength training protocol needs to be employed in younger adults as means of prevention and staying healthy into the golden years!


Written by Yuri Elkaim, BPHE, CK. Do not reprint without permission
Copyright 2006 © Total Wellness Consulting.

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EDITOR'S NOTE _ This story is the result of a collaboration between U.S. News and Kaiser Health News. Steve Sternberg and Chris Young, both of U.S. News, analyzed government data on nearly 9,000 health plans; U.S. News has separately published the plan data in Best Health Insurance Plans. Kaiser's Julie Appleby further analyzed the data and reported and wrote the story.

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Gail Harriman's health insurance costs rose four times in just over two years, from $550 a month to $1,171, an amount "more than my mortgage." But when the self-employed San Francisco resident tried to switch insurers, she was rejected because of a minor health problem.

Harriman, 60, is among the estimated 15 million Americans who buy their own insurance and face far bigger hurdles getting and keeping it than those with job-based coverage.

"Most people who work for a company have absolutely no clue about what goes on with people who buy their own insurance," she said. "I would never consider going without. But there have been moments when I feel it's the bane of my existence."

Most of the debate about how the health law will change the individual market has centered on whether consumers will experience "rate shock" from higher premiums when key changes go into effect next year. But there's a flip side: new rules that broaden benefits, prohibit discrimination against those with health issues and cap consumers' out-of-pocket costs, which can cut far deeper than premiums.

Currently, about one in five plans sold to consumers makes them responsible for at least half their medical costs after they've paid their premiums and met their deductibles, according to an analysis of government data by U.S. News & World Report and Kaiser Health News. It could not be determined how many consumers have such plans.

"The individual market before and after Jan. 1 will be fundamentally different places," said Robert Laszewski, a former insurance executive who now consults for the industry.

Beginning Jan. 1, Insurers Can't Turn People Away

The new rules bar insurers from rejecting applicants with health problems, set limits on how much more they can charge older residents and also require most Americans to carry coverage or face a fine.

Whether individuals will be better or worse off under those rules depends on their age, health status, where they live – and perhaps most important, whether they end up needing substantial medical care in the coming year. Generally speaking, those who are younger and healthier may pay more than they would have, while older and sicker people are likely to be better off.

"Every one of those actions, as well intended and over the long-term as good as they are, will have short term negative consequences for some people," said Laszewski.

Coverage under the health law will still require cost-sharing, potentially running into thousands of dollars. But those amounts will be clearly laid out – helping those who now "might buy insurance that looks cheap, but when they get sick they realize they didn't read all the fine print and it doesn't cover what they thought it did," said Uwe Reinhardt, a Princeton economics professor.

[Read Poll: More Than Half of Americans Think Obamacare Will Make Lives Worse]

The single biggest change next year is that insurers will no longer be able to reject people with health problems or charge them more based solely on their health history – a practice that has barred some people from the market, and prevented others from being able to switch plans. Insurers were already prohibited from doing that to enrollees in group health plans, such as those sold to employers.

That change will be a huge relief for Maureen Mitchell, 58, of St. Augustine, Fla., who has spent most of the past decade uninsured after being rejected by insurers because of a heart rhythm abnormality.

Last September, Mitchell awoke with a stabbing pain in her chest and did a mental calculation: If she called for help, she would face large bills for hospital care and the ambulance ride. If she didn't call, she might die. "I just didn't have that money," said Mitchell, who did not call 911.

Forty-nine percent of Americans under the age of 65 report they or a family member have a pre-existing medical condition such as heart disease, diabetes, asthma, and cancer. Among this group, a quarter say they or someone in their household has been denied coverage, or had their premium raised, because of a pre-existing condition.

Cost-Sharing May Still Be A Struggle

The law will also put limits on high-deductible policies like those chosen by Laurie Simons, 62, and Mary McVey, 50 – meaning they pay significant sums out of their own pockets before their coverage kicks in.

Starting in January, new policies must cap annual "out-of-pocket" costs, which include deductibles and co-insurance payments, to about $6,350 for an individual, or $12,700 for a family – amounts that could still be a stretch for many consumers.

"There aren't that many Americans who have that kind of cash just sitting around," said Karen Pollitz of the Kaiser Family Foundation, who has studied the individual market. (KHN is an editorially independent program of the foundation.) "For the middle-class uninsured, it may still be a struggle."

Nonetheless, the law's caps will reduce the cost-sharing in many plans currently sold, including those purchased by Simons and McVey.

Almost a third of plans currently offered to consumers exceed those caps, according to the U.S. News/Kaiser Health News analysis.

[Read Many Insurance Plans Heap Healthcare Costs on Consumers.]

When Simons, a self-employed mental health counselor in Portland, Maine, switched to a high-deductible plan to reduce her monthly costs, she was healthy. But earlier this year, she was diagnosed with melanoma. Now she must find $11,000 to pay for her surgery.

"If you don't have money, I don't know what you do," Simons said.

She hopes that next year she can buy coverage that would protect her against five-figure medical bills.

McVey, on the other hand, wants to keep her policy, saying she is not willing to pay much more than her current premium of about $500 per month for a family of five. The self-employed accountant in Cape Elizabeth, Maine, has a policy that carries a $15,000 deductible, which could rise to $30,000 if two or more family members fall seriously ill in the same year.

McVey admits she's been lucky that no one in her family has ever faced serious medical problems. She hardly ever goes to the doctor, she said, and offers cash when she does, hoping for a discount.

She worked out a payment policy with the hospitals that delivered her three children – and paid each of the bills off over several years with payments of $50 to $100 a month.

While she would love "a health policy where I don't have to pay $700 to get a checkup for my kids," she said she would not like it if the tradeoff is higher premiums.

"Paying $1,200 or more a month for health insurance seems like craziness," she said.

Steve Sternberg and Chris Young of U.S. News contributed to this report by Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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