Abstract
Age-related loss of muscle mass and function, also called sarcopenia, was recently added to the ICD-10 as an independent condition. However, declines in muscle mass and function are inevitable during the adulthood aging process. Concerning muscle strength as a crucial aspect of muscle function, maximum knee extension strength might be the most important physical parameter for independent living in the community. In this study, we aimed to determine the age-related decline in maximum isokinetic knee extension (MIES) and flexion strength (MIFS) in adult men. The primary study hypothesis was that there is a slight gradual decrease of MIES up to ≈age 60 years with a significant acceleration of decline after this “changepoint.” We used a closed kinetic chain system (leg-press), which is seen as providing functionally more relevant results on maximum strength, to determine changes in maximum isokinetic hip/leg extensor (MIES) and flexor strength (MIFS) during adulthood in men. Apart from average annual changes, we aimed to identify whether the decline in maximum lower extremity strength is linear. MIES and MIFS data determined by an isokinetic leg-press of 362 non-athletic, healthy, and community-dwelling men 19–91 years old were included in the analysis. A changepoint analysis was conducted based on a multiple regression analysis adjusted for selected co-variables that might confound the proper relationship between age and maximum strength. In summary, maximum isokinetic leg-strength decline during adulthood averaged around 0.8–1.0% p.a.; however, the reduction was far from linear. MIES demonstrated a non-significant reduction of 5.2 N/p.a. (≈0.15% p.a.) up to the estimated breakpoint of 52.0 years and an accelerated loss of 44.0 N/p.a. (≈1.3% p.a.; p < 0.001). In parallel, the decline in MIFS (10.0 N/p.a.; ≈0.5% p.a.) prior to the breakpoint at age 59.0 years was significantly more pronounced. Nevertheless, we observed a further marked accelerated loss of MIFS (25.0 N/p.a.; ≈1.3% p.a.) in men ≥60 years. Apart from the “normative value” and closed kinetic chain aspect of this study, the practical application of our results suggests that sarcopenia prophylaxis in men should be started in the 5th decade in order to address the accelerated muscle decline of advanced age.
Highlights
Sarcopenia, characterized as a reduction of muscular mass and -function (Cruz-Jentoft et al, 2010; Fielding et al, 2011; Studenski et al, 2014) was included in the ICD-10 CM1 code as a musculoskeletal disease in 2016 (M62.84)
All the studies were conducted between February 2008 and May 2018 by the Institute of Medical Physics (IMP), Friedrich-Alexander University (FAU) of Erlangen-Nürnberg
Our most striking motivation for focusing on hip/leg extension strength was the particular relevance of leg-extension strength on mobility limitations, disability, morbidity, and mortality in older people (Visser et al, 2005; Newman et al, 2006; Roshanravan et al, 2017)
Summary
Sarcopenia, characterized as a reduction of muscular mass and -function (Cruz-Jentoft et al, 2010; Fielding et al, 2011; Studenski et al, 2014) was included in the ICD-10 CM1 code as a musculoskeletal disease in 2016 (M62.84). The relevance of muscle mass for healthy aging might be underestimated; functional or more dedicated “dynamopenic” (Greco et al, 2014) aspects are without doubt more important for older people’s well-being and independent living. In this context, studies have reported the particular crucial relevance of age-dependent declines in leg-extension/quadriceps strength on mobility limitations, disability, morbidity, and mortality in older people (Visser et al, 2005; Newman et al, 2006; Roshanravan et al, 2017). Age-related declines in muscle mass, strength and function are inevitable developments in human adults. What is the “normal age-appropriate” decline of muscle mass and function? Further, is this decline linear over the adult lifespan or are there changepoints of an accelerated loss of lower extremity muscle parameters?
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