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Sarcopenia and the Aquatic Environment

 

 

    Author by Peggy Myrick, BS

 

Sarcopenia is a condition commonly associated with aging and characterized by loss of muscle mass, strength, and function. Deterioration of muscular fitness negatively impacts the ability to perform everyday tasks, which may eventually lead to loss of independence. This article is intended to bring awareness to the disorder and reassurance to older adults that the aquatic environment can benefit those with, or at risk for developing, sarcopenia. Symptoms, risks, causes, treatments, and research will be discussed as well as a few ways to mitigate sarcopenia within the water world.

Symptoms

There is no specific degree of muscle mass loss, and no test exists, that will diagnose sarcopenia; however, individuals with this condition may experience: (Raj 2018 & WebMD 2018)

  • Unintentional weight loss
  • Weakness, loss of stamina
  • Reduction in muscle size
  • Unsteady gait
  • Trouble climbing stairs
  • Difficulty lifting familiar objects
  • Poor balance, leading to an increased fall risk.

 

Risk Factors/Causes

Age. The International Osteoporosis Foundation reports that muscle mass starts to diminish by the time a person reaches age 40. Sarcopenia affects approximately 10 percent of people over the age of 60, at which time the loss of muscle tissue often becomes swift (Tekton 2020).

Malnutrition. Older adults are prone to a reduction in food intake which may result in malnutrition. Malnutrition can cause protein deficiency, which further fuels muscle loss, because protein-rich foods build and mend muscle fibers (IOF 2017).

Lifestyle. Having a sedentary lifestyle translates to muscle inactivity and, therefore, decreases in muscle mass and strength (IOF 2017).

Inflammation. Diets high in pro-inflammatory foods can often induce chronic low-grade inflammation which adversely affects muscle mass and strength (Greco et al., 2019).

Hormonal imbalance. Growth hormone regulates production of the insulin growth factor 1 and both substances are crucial protein anabolic agents for body balance. However, the concentration of some {source L} hormones, including growth hormone and insulin-like growth factor, can become depressed or out-of-balance, contributing to loss of muscle mass and strength (Vale et al., 2017).

Treatments/Preventative Measures

A sensible, well-balanced, diet which includes high-quality protein can slow the rate of muscle decline.  However, most authorities agree that exercising is the most effective way to prevent, decelerate, or even reverse sarcopenia (Thorpe 2017). Currently there are no approved drug therapies for sarcopenia, but a few are being studied; for example, medication for the treatment of metabolic syndrome (e.g., hypertension and insulin-resistance) (WebMD 2018). Some health care professionals advocate hormone therapy, but more studies are needed to determine the effectiveness of hormonal intervention. Therapies would presumably be used with exercise, not instead of it (Raj 2018).

Research Review

A recent systematic review and meta-analysis based on 25 independent studies explored the relationship between physical activity and sarcopenia in older adults. A statistically significant relationship between physical activity and sarcopenia, as well as the protective role exercise plays against sarcopenia development, was documented in most of the 25 reviewed studies. Moreover, the meta-analysis suggested that physical activity trims the odds of acquiring sarcopenia in later life (Steffl et al., 2017).

Many studies purport that some exercises are better than others for preventing and treating the malady. For example, resistance (strength) training is typically identified as the preferred exercise prescription to mitigate decreases in muscle mass. Resistance training engages the muscles causing an increase in growth-promoting hormones that tell the body to create more muscle tissue.

Research by Vale et. al. (2017) reported that the aquatic environment places inconsequential amounts of strain on your bones and joints, producing only superficial muscle damage. The implication being that aquatic exercises may bring about lower strength gains (than land exercises) due to less muscle stimulation, strain, or damage. The results suggest that land resistance training provides greater anabolic benefits than water resistance training.

However, Konopka and Harber (2014) found that “aerobic” or “cardio” exercise training is a feasible exercise protocol to decrease age-related losses in muscle mass because of a reduction in catabolic gene expression and increased muscle protein synthesis that promote muscle growth. These researchers speculate that correctly performed aerobic exercise leads to skeletal muscle hypertrophy paralleling resistance training. They conducted a series of studies implementing 12 weeks of either resistance or aerobic exercise training which showed that both modes of exercise elicited a similar increase in quadriceps muscle volume suggesting both types of exercise are effective at stimulating muscle hypertrophy.

Based on one study, water walking can help prevent and may even reverse sarcopenia.  This study followed 227 adults over 65 and found that after six months of water walking, their muscle mass had increased (Thorpe 2017). Additionally, a randomized controlled trial that analyzed the relative impacts of land-walking and water-walking on fitness, showed that they induced similar improvements in fitness if performed at equivalent intensities. This study also reported changes in body composition favoring increased lower limb lean body mass as a consequence of water-walking compared to land-walking.  This indicates that drag forces and water resistance encountered during water-walking may be responsible for muscle mass adaptations at least as beneficial as land-walking (Haynes et al., 2019).

Beneficial Aquatic Facts

Water possesses many unique properties and operates according to various principles and laws of motion allowing the water world to be a safe, comfortable, and effective medium for anyone of any age to better their strength, flexibility, balance, cardiorespiratory health, and functional fitness. This may be reassuring to individuals who cannot tolerate land-based training and are vulnerable to age-related muscle wasting. Consider the following water facts:

Buoyancy assists in increasing range of motion (ROM) that, consequently, facilitates everyday routines such as looking over one's shoulder to check for traffic or reaching up to put dishes away. And, because better ROM usually allows an individual to participate more fully in exercise, improvements in muscular health and physical strength often result. Buoyancy reduces the effects of gravity so there is less pounding of the joints, allowing individuals to move freely and with decreased pain while water walking/running or performing any one of the other numerous aquatic activities (Neff et. al., 2019 & AEA 2018).

Viscosity, or the friction between molecules which makes molecules cling to each other and to a submerged human body, causes resistance to motion. Water supplies significantly more resistance to motion than air. Viscous resistance encourages muscle strengthening with or without aquatic equipment and, furthermore, movements performed underwater are resisted in all directions, thus working muscles in pairs (Grevelding 2015).

Drag is a powerful tool to use for exercise regression and progression. It is the resistance you feel to movement in the water and is a function of viscosity, frontal shape, size, and the relative velocity between the exerciser and the water. Muscle load decreases on land when you achieve a sustained speed, but water exercise provides a constant muscle load through full range of motion. Additionally, drag is experienced with each movement and in all directions. By changing the surface area and/or shape of the body or the body part and by altering movement speed, individuals can make an exercise more intense or easier to perform (AEA 2018).

Speed of movement can be an effective means to train muscles. Since the resistance of the water increases with the speed of movement, additional muscular effort and more muscle fiber recruitment are required (Neff et. al., 2019 & AEA 2018).

Aquatic Exercise vs. Sarcopenia

Most authorities agree that exercising is the most effective way to fight sarcopenia (Thorpe 2017), so let's see how we can use aquatic exercise to our advantage in the battle against muscle deterioration.

A basic aqua class to mitigate sarcopenia might look like this:

  • Total body warm-up
  • Muscular strength training with aquatic equipment
  • Muscular endurance training
  • Aerobic training
  • Cool-down and stretches to include balance training

 

Muscular strength refers to the amount of force a muscle can manufacture with a single maximal effort. Training for strength involves greater resistance with fewer repetitions than endurance training. The focus is on using the resistance of the water in conjunction with the application of acceleration (force) and aquatic equipment, such as foam dumbbells, rigid hand paddles, or lower body fins. Strength training may be advanced by working to muscle fatigue and by introducing more intense resistance equipment. A few exercise options are breaststroke; shoulder abduction and adduction; knee flexion and extension; alternating front kicks; etc. (AEA 2018).

Muscular endurance is the capacity of a muscle to exert force repeatedly or to hold a static contraction over time. Train for endurance using moderate resistance with more repetitions than strength training. Using the resistance of the water is a superb way to boost and sustain muscular endurance. Resistance can be progressively increased by applying more force against the water's resistance, increasing surface area or lever length, or adding equipment (AEA 2018). Although muscular endurance is not specifically identified in the definition of sarcopenia, muscular strength and muscular endurance are interrelated; that is, training endurance is going to positively affect strength. Endurance exercise options are similar to strength options.

Aerobic or cardio exercise can induce skeletal muscle hypertrophy in sedentary older adults, according to several recent studies. The caveat? Resistance training and “cardio” training may produce similar physiological responses and adaptations where effort and duration are equivalent. Whether instructing or exercising, be mindful that the effectiveness of aerobic exercise training to stimulate skeletal muscle hypertrophy likely is contingent on obtaining adequate exercise intensity, duration, and frequency: (70-80% HRR; 30-45 minutes; 4-5 days per week) (Konopka and Harber 2014). Aquatic aerobic exercise examples (deep/shallow) include jogging, ankle reach front, kick, cross-country ski, and more.

Balance training is a valuable component of any class format, and it is incredibly fun and usually ignites laughter among class participants. Improving balance also reduces fall risk and enhances our odds for living independently into old age. Ideas to try

  • Walk on an imaginary “balance beam” in the pool. progress the training by adding a stop-and-go element or by raising the hands out of the water
  • Experiment with various static stances: narrow, wide, staggered, tandem, single leg, etc.  Progress to closing eyes or turning the head while holding the stance. Create a dynamic scenario with partner work: one partner freezes in a stance, while the other partner makes waves, literally, increasing the balance challenge for the static partner.

 

Final Thoughts

Aquatic fitness professionals consider their participant's needs and the unique properties and principles of water when building an aquatic exercise class. They manipulate the water to help participants improve their quality of life and maintain independence. Since adaptations to any exercise training program are variable among the participants, an optimal exercise prescription for older adults maximizes beneficial adaptations while minimizing potential risk (Haynes et al., 2019).

REFERENCES

AEA. 2018. Aquatic Fitness Professional Manual, seventh edition. Champaign, IL: Human Kinetics

Greco, E.A., P. Pietschmann, S. Migliaccio. 2019. Osteoporosis and Sarcopenia Increase Frailty Syndrome in the Elderly. Front Endocrinol (Lausanne). 10:255.

Grevelding, M. 2015. Why Water? markgrev@fitmotivation.com

Haynes, A., L.H. Naylor, H.H. Carter, A.L. Spence, E. Robey, K.L. Cox, B.A. Maslen, N.T. Lautenschlager, N.D. Ridgers, D.J. Green. 2019. Land-Walking vs. Water-Walking Interventions in Older Adults: Effects on Aerobic Fitness. Journal of Sport and Health Science. https://sciencedirect.com/science/article/pii/S2095254619301504

Konopka, A.R., and M.P. Harber. 2014. Skeletal Muscle Hypertrophy after Aerobic Exercise Training. Exerc Sport Sci Rev 42(2): 53-61.

Neff, A., M. Leary, L. Sherlock. 2019. Developing Strength in an Aquatic Environment. IAFC 2019 Research Summary & Sample Workout.

Raj, M.D. 2018. What is Sarcopenia? Healthool. https://healthool.com/sarcopenia/

Steffl, M., R.W. Bohannon, L.Sontakova, J.Tufano, K.Shiells, I.Holmerova. 2017. Relationship Between Sarcopenia and Physical Activity in Older People: A Systematic Review and Meta- Analysis. Clin Interv Aging 12:835-45.

Thorpe, M., 2017. How to Fight Sarcopenia (Muscle Loss Due to Aging). Healthline. https://www.healthline.com/nutrition/sarcopenia

Using Exercise to Combat Sarcopenia. 30 January 2020. Tekton Research.

Vale, R.G.d.S., M.L.D. Ferrao, R.d.A. Moreira, J.B.d. Silva, R.J.N. Junior, E.H.M. Dantas. 2017. Muscle Strength, GH and IGF-1 In Older Women Submitted to Land and Aquatic Resistance Training. Rev Bras Med Esporte 23(4)

WebMD Medical Reference. 2018. Sarcopenia With Aging. https://www.webmd.com/healthy- aging/guide/sarcopenia-with-aging?print=true

What is Sarcopenia. 2010. International Osteoporosis Foundation. https://www.iofbonehealth.org/what-sarcopenia

Who's At Risk? 2017. International Osteoporosis Foundation.

https://www.iofbonehealth.org/whos-risk-0

 

AUTHOR

Peggy Myrick, BS in Mathematics from Auburn University at Montgomery, AL, began lifting weights at age 40. She has competed in a few amateur bodybuilding competitions during the last 20 years. Peggy has been teaching Aqua since 2012 and Tai Chi since 2019. She is AEA certified and also certified through Open the Door to Tai Chi. She is passionate about teaching older adults. Email: pmyrick1953@gmail.com

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