Exercise and nutritional approaches to prevent frail bones, falls and fractures: an update

Abstract

Osteoporosis (low bone strength) and sarcopenia (low muscle mass, strength and/or impaired function) often co-exist (hence the term 'sarco-osteoporosis') and have similar health consequences with regard to disability, falls, frailty and fractures. Exercise and adequate nutrition, particularly with regard to vitamin D, calcium and protein, are key lifestyle approaches that can simultaneously optimize bone, muscle and functional outcomes in older people, if they are individually tailored and appropriately prescribed in terms of the type and dose. Not all forms of exercise are equally effective for optimizing musculoskeletal health. Regular walking alone has little or no effect on bone or muscle. Traditional progressive resistance training (PRT) is effective for improving muscle mass, size and strength, but it has mixed effects on muscle function and falls which may be due to the common prescription of slow and controlled movement patterns. At present, targeted multi-modal programs incorporating traditional and high-velocity PRT, weight-bearing impact exercises and challenging balance/mobility activities appear to be most effective for optimizing musculoskeletal health and function. Reducing and breaking up sitting time may also help attenuate muscle loss. There is also evidence to support an interaction between exercise and various nutritional factors, particularly protein and some multi-nutrient supplements, on muscle and bone health in the elderly. This review summary provides an overview of the latest evidence with regard to the optimal type and dose of exercise and the role of various nutritional factors for preventing bone and muscle loss and improving functional capacity in older people.

Muscle wasting and sarcopenia in heart failure and beyond: update 2017

“…Resistance exercise is often used in combination with nutrition support, which increases muscle mass and muscle strength more than exercise alone . Supplementation of a low dose creatine in combination with resistance training improved lean mass in elderly over a period of 12 weeks .…”

“…69 Resistance exercise is often used in combination with nutrition support, which increases muscle mass and muscle strength more than exercise alone. 41,[70][71][72] Supplementation of a low dose creatine in combination with resistance training improved lean mass in elderly over a period of 12 weeks. 73 In a patient-centered exercise approach in frail elderly and older adults with mobility limitations, physical activity was considered to improve effective quality of life and reduce frailty, while also being cost-effective.…”

Skeletal muscle wasting in chronic heart failure

“…82 Resistance exercise is often used in combination with nutrition support, which increases muscle mass and muscle strength more than exercise alone. 46,[83][84][85] Supplementation of a low-dose creatine in combination with resistance training improved lean mass in elderly over a period of 12 weeks. 86 A patientcentred exercise approach in frail elderly and older adults with mobility limitations physical activity was considered to improve effective quality of life and reduce frailty, while also being cost-effective.…”

Osteoblasts infill irregular pores under curvature and porosity controls: a hypothesis-testing analysis of cell behaviours

“…The underlying biological and physical processes involved in a curvature control of bone formation are likely to be fundamentally different from those involved in a porosity control of bone formation. This distinction could thus be important for understanding the evolution of age-related bone loss, and how to best counter it [38,39]. To our knowledge, this is the first time that a mathematical model of cell population is used in combination with experimental data to gain insights into geometric influences at the level of individual cells.…”