Curling Consequences
Shortcut to the impacts of elderly fractures and the related benefits of resistance training
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What’s the point of lifting weights? Throughout the Muscle Mania Series, we explored the in’s and out’s of muscle hypertrophy, including both the cellular mechanisms behind muscle growth and research regarding training protocols for making gains; however, we didn’t spend much time answering the, “why?” of resistance training. Many, including myself, are attracted to lifting weights for, amongst others, the aesthetic and athletic benefits – looking muscular and getting stronger – but these endpoints are arbitrary and/or uninteresting for others. If you’re a part of the latter crowd, you may still be enticed to lift weights in light of the considerable health benefits. Here, we’ll talk about one of those in particular: mitigating risk of elderly fractures.
If you’re like me, then it is not uncommon for you to hear about an elderly family member or friend falling and hurting themselves; furthermore, you probably don’t realize the mortality implications with such falls. Maybe this is because you’ve spent a lot of time playing or spectating sports where fractures often occur with – though painful – less than grave consequences to follow. I mean, these are just broken bones, a few months in a cast and maybe a plate or screw here and there and everything’s fine, right? For a 10 year-old playing pop warner, it’s true that a relatively safe surgery and a few months off of the field with a sling, boot, or crutches are typically the worst to come after a fracture; contrarily, the story is entirely different concerning somebody over the age of 60, especially when it comes to hip fractures.
In 2017, Katsoulis et al. conducted a massive prospective observational study – meaning that they followed and collected data on the subjects at baseline and throughout the study period – investigating the repercussions of hip fractures in 122,808 subjects aged 60 and older. (I) The researchers followed patients from several large cohorts – groups of patients already being observed for separate studies – from Greece, Sweden, Germany, Norway, USA, and Czech Republic for a mean of 12.6 years, during which there were 4,273 total hip fractures. (I) At the conclusion of the study, the overall hazard ratio for hip fractures and mortality was 2.12; additionally, the hazard ratio for hip fractures and mortality in the 1-year period following the fracture was 2.78. (I) In terms of relative risk, this suggests that fracturing your hip at the age of 60 or older leads to a 112% increased risk of death overall and a 178% increased risk of death in the year following the fracture. Check out Figure 1 to see what this looks like in terms of absolute risk based on the latest Social Security Administration mortality rates.
The data for 80-year-olds speaks for itself: 16.90% and 12.18% mortality rates for males and females post-fracture, respectively. And, though the absolute risk increases at age 60 and even age 70 are not enormous, any event that increases 1-year mortality rate by close to a factor of 3 is a cause for concern if your lifespan is important to you, in my opinion – especially if it’s an acute event and can be largely mitigated. Plus, the impact on quality of life following a fracture at these ages is intuitively and reportedly no joke. (II)
So, what does this have to do with pumping iron? Sarcopenia, loss of muscle mass and strength with aging, is a key risk factor for accidental falls – a major cause of elderly fractures. Resistance training offers a method of not only blunting muscle and strength loss but actually increasing muscle mass and strength, in both younger and elderly subjects. (I, II, III)
If you read the Muscle Mania Series, you’re well aware of the abundant data regarding muscle hypertrophy as a whole and especially for younger adults. In terms of age-related specifics, Bickel and colleagues demonstrated that both resistance training- induced muscle hypertrophy and strength gains are available to older populatons as well; intriguingly, they also showed that one group of 60-75-year-olds’ strength gains acquired from a 16-week lower-body weight lifting protocol remained elevated even after refraining from weight lifting altogether for 32 weeks. In fact, not only did the older subjects in that group maintain much of their strength gains after that 32-week stint, their specific strength – defined as the ratio of 1-repetition-maximum (1RM) leg extension to thigh lean mass – remained higher than the average baseline specific strength of the study’s 20-35 year-olds. (III)
To be fair, the subjects in Bickel and colleagues’ study had not resistance trained their lower bodies for 5 years prior to the experiment, and the older subjects in the complete and partial detraining groups – utilizing either 0, 1/9, or 1/3 of the training volume from the first 16-week protocol – lost much or all of their muscle mass gains after the 32-week detraining phase of the study. (III) Still, the 60-75-year-olds’ 4.3% increase in lean thigh mass, 40% increase in 1RM knee extension, 14.2% increase in type I muscle fiber cross-sectional area (CSA), and 28.5% increase in type II muscle fiber CSA are impressive for 16 weeks of resistance training. (III) Check out Figures 2, 3, and 4 for visuals of some of these results side-by-side with the younger subjects’ results from this study.
Though the responses likely would have been lower in a group of subjects who had already been resistance training, the question remains: how much more muscle mass and strength could the older subjects have acquired if they continued training for the entirety of the year? Likely more than enough to meaningfully mitigate accidental falls and the severity of related injuries. And, outside of aesthetic, athletic, and additional health reasons, that’s the point of lifting weights.