1

UNIT III
Effect of Exercise, age,
and disuse

Effect of exercise
It means movement that generates aerobic debt and

increased heart rate.

Reduced mortality rates, even for smokers and the obese
Preservation of skeletal muscle strength, aerobic capacity,
and bone density, contributing to mobility and
independence
Reduced risk of obesity
Prevention and treatment of cardiovascular disorders,
diabetes, osteoporosis and psychiatric disorders
(especially mood disorders)
Prevention of falls and fall-related injuries by improving
muscle strength, balance, coordination, joint function, and
endurance

Exercise programs
Exercise programs that are more strenuous than walking may

include any combination of 4 types of exercise:

endurance, muscle strengthening, balance training(eg, tai-chi), and
flexibility
The combination of exercises recommended depends on the
patients medical condition and fitness level.
For example, a seated exercise program that uses cuff weights for
strength training and repeated movements for endurance training
may be useful for patients who have difficulty standing and walking.
An aquatics exercise program may be suggested for patients with
arthritis.
Of all types of exercise, endurance exercises (eg, walking, cycling,
dancing, swimming, low-impact aerobics) have the most welldocumented health benefits for the elderly.

Drugs and exercise

Doses of insulin and oral hypoglycemics in diabetics may need to be

adjusted (according to the amount of anticipated exercise) to prevent

hypoglycemia during exercise.
Doses of drugs that can cause orthostatic hypotension (eg,
antidepressants, antihypertensives,) may need to be lowered to avoid
exacerbation of orthostasis by fluid loss during exercise.
For patients taking such drugs, adequate fluid intake is essential
during exercise.
Some sedative-hypnotics may reduce physical performance by
reducing activity levels or by inhibiting effects on muscles and nerves.
These and other psychoactive drugs increase the risk of falls.
Stopping such drugs or reducing their dose may be necessary to
make exercise safe and to help patients adhere to their exercise
regimen.

Exercise and aging

Exercise can prevent many age-related changes to muscles, bones and

joints and reverse these changes as well.

Research shows that Exercise can make bones stronger and help slow the
rate of bone loss.
Older people can increase muscle mass and strength through musclestrengthening activities.
Balance and coordination exercises, such as tai chi, can help reduce the
risk of falls.
Physical activity in later life may delay the progression of osteoporosis as it
slows down the rate at which bone mineral density is reduced.
Weight-bearing exercise, such as walking or weight training, is the best type
of exercise for maintenance of bone mass.
Older people who exercise in water (which is not weight bearing) may still
experience increases in bone and muscle mass compared to sedentary
older people.
Stretching is another excellent way to help maintain joint flexibility.

Age-related changes in muscle

Muscle looses size and strength
Leading to fatigue, weakness and reduced tolerance to

exercise.
Muscle fibres reduce in number and shrink in size.
Muscle tissue is replaced more slowly and lost muscle
tissue is replaced with a tough, fibrous tissue.
Changes in the nervous system cause muscles to have
reduced tone and ability to contract.

Age-related changes in bone

Bone is living tissue.
With age, the structure of bone changes and resulting in

loss of bone tissue.

Low bone mass means bones are weaker and higher risk
of breaks from a sudden bump or fall.
Bones become less dense as we age for a number of
reasons, including:
An inactive lifestyle causes bone wastage.
Hormonal changes
Bones lose calcium and other minerals.

Age-related changes in joints

With age, joint movement becomes stiffer and less flexible
Because the amount of lubricating fluid inside your joints

decreases and the cartilage becomes thinner.

Ligaments also tend to shorten and lose some flexibility,
making joints feel stiff.
Many of these age-related changes to joints are caused by
lack of exercise.
Movement of the joint, and the associated stress of
movement, helps keep the fluid moving.
Being inactive causes the cartilage to shrink and stiffen,
reducing joint mobility.

Muscle and bone conditions in older age

Nearly half of all Australians over the age of 75 years have

some kind of disability. Common conditions affecting muscles

and the skeleton, or the musculoskeletal system, in older
people include:
Osteoarthritis the cartilage within the joint breaks down,
causing pain and stiffness
Osteomalacia the bones become soft, due to problems with
the metabolism of vitamin D
Osteoporosis the bones lose mass and become brittle.
Fractures are more likely
Rheumatoid arthritis inflammation of the joints
Muscle weakness and pain any of the above conditions
can affect the proper functioning of the associated muscles.

10

Effect of rest
Bedrest is often necessary for healing injured or diseased

parts of the body.

However, it is now well established that extensive periods
of bedrest can cause harm to the rest of the body.
The most obvious effects of long periods of immobility are
seen in the musculoskeletal system,
The loss of muscle strength and endurance, and bone
weakening.
Bones undergo a progressive loss in mass through a
condition known as disuse osteoporosis.
Immobility is also linked with altered skin integrity and can
affect the immune system.

11

Effect of rest
The musculoskeletal system (with the help of the central

nervous system) provides mobility and the ability to carry

out normal daily activities.
Any muscle weakness or joint and bone stiffness through
immobility or disuse has an impact on these functions
and may also increase the risk of injury or infection.
Muscles
Disuse of the muscles leads to atrophy and a loss of
muscle strength at a rate of around 12% a week.
After 35 weeks of bedrest, almost half the normal
strength of a muscle is lost.

12

Effect on muscles
Skeletal, voluntary muscle mainly consists of two types of

fibres slow-twitch (type 1) and fast-twitch (type 2).

Slow-twitch fibres contract slowly and produce large
amounts of energy to enable them to keep going for a long
time.
They also house large amounts of myoglobin (a protein that
stores oxygen) and contain numerous blood capillaries,
which make them very resistant to fatigue.
These fibres are predominantly found in the muscles of the
neck and back where they help to maintain posture.
They are also abundant in the soleus muscle of the lower leg
and aid endurance activities such as long-distance running.

13

Fast-twitch muscle fibres contract quickly but rapidly get tired.

Found in large numbers in the muscles of the arm these fibres

are perfectly adapted for rapid movements but consume lots of

energy.
Since they are not able to generate sufficient energy for a
continuous supply of adenosine triphosphate (ATP), they are
tired easily.
Long periods of immobility have different effects on these two
types of muscle fibres.
Studies have been conflicting on whether one type atrophies
faster than the other .
However, it is known that fibre atrophy occurs and leads quickly
to a loss of strength and mass in the postural muscles of the
back, legs and arms.

14

In elite athletes, inactivity after injury or immobilisation rapidly

affects the size and aerobic capacity of both fibre types.

In endurance athletes, type 1 fibres are mainly affected, while in
sprinters it is the type 2 fibres that atrophy
Atrophy can occur after only a short period of immobility.
One study found that 72 hours of limb immobilisation can cause
atrophy of type 1 and type 2 fibres by 14% and 17%
respectively .
It appears that the larger and better trained the muscle, the
faster the loss of muscle strength, and the quicker the
deconditioning process .
The first muscles to become weak are those in the lower limbs
that normally resist gravitational forces in the upright position.
Skeletal muscles lose tone when the feet no longer bear weight.

15

In general, extensor muscles, which have a prime postural

role, atrophy to a greater extent than flexor muscles (such as

hamstrings).
When muscles are immobilised, they shorten.
A programme of immediate or early motion may prevent
muscle atrophy.
However, atrophy of the quadriceps muscle (the forced
immobility of a rigid plaster cast) cannot be reversed through
the use of isometric exercises.
The number of sarcomeres (muscle filaments) decreases
when muscles are kept in a shortened position.
The extent of atrophy is significantly increased if the muscle
is kept in the contracted position.

16

Dietrich showed that immobilisation of the elbow joint for

five weeks caused a 3541% reduction in elbow

extension strength.
After five weeks of strict bedrest, muscles showed a
remarkable decrease in strength.
It takes about four weeks to recover from atrophy caused
by immobility a slower process than recovery from direct
muscle trauma.
Disuse weakness is reversed at a rate of only 6% per
week with exercise.

17

Connective tissue
Tendons, ligaments and articular cartilage require

motion to stay healthy and will therefore undergo

changes when patients are immobile.
Changes in the structure and function of connective
tissue become apparent four to six days after
immobility begins
and these changes remain even after normal activity
has been resumed.
Most of these changes are due to altered structure of
collagen fibres.
About 20 days of bedrest reduces the stiffness of
tendons and increases their viscosity .

18

This affects transmission from muscle fibres to bone and

reduces the ability to produce dynamic force, resulting in

a weaker and more exhausted patient.
Ligament are affected biomechanically, biochemically and
morphologically by immobility.
Experiments show that ligament stiffness and loadbearing ability drop to 69% and 61% below normal
respectively,
The ligaments do not return to normal after one year
(Zarrins, 1982).

19

Contractures
Any decrease from the normal range in parts of the body

responsible for motion for example joints, ligaments, tendons

and related muscles is known as a contracture
It can be transient, such as morning stiffness after eight hours of
sleep in a curled-up position, which can be easily corrected by
stretching in the opposite direction.
However, 23 weeks of immobilisation will produce a much
firmer contracture, and this is a frequent complication of bedrest.
Muscle atrophy plays a part in the development of contractures
because of the abnormal shortening and weakening of the
muscle.
Contractures can develop over joints, often when there is an
imbalance in the muscle strength of opposing muscle groups.

20

If allowed to progress, a contracture may go on to involve the

muscles, tendons, ligaments and joint capsule, causing a stiff joint,

limited in its full use and range of motion.
An example is contracture of the knee after plaster immobilisation
to treat a fractured tibia.
The basic component of connective tissue is the protein collagen,
which is arranged in fibres.
In areas that move frequently, the fibres are in a loosely coiled
arrangement that permits normal stretching and activity.
Immobilisation causes them to change into a mass of shortened,
straightened and more densely packed fibres, and these changes
can occur after less than one day.
In 23 weeks a firmer contracture develops. After 23 months of
immobility, surgical correction may be needed.

21

Effect on Muscles
Exercise

Aging

Disuse

Muscles challenged
by exercise beyond
their ability, increase
in size and strength.

As we age, muscle
mass decreases
and the muscles
become more
sinewy.

Inactive muscles
atrophy

Muscles subjected
to regular aerobic
exercise become
more efficient and
stronger and can
work longer without
tiring

Without exercise,
they atrophy; with
extremely vigorous
exercise, they
hypertrophy

22

Muscle fatigue
If a muscle is stimulated to contract at very frequent

intervals, it gradually becomes depressed and will cease

to respond.
Fatigue is prevented during sustained muscular effort
because fibers usually contract in series.
All the fibers of muscle rarely contract at the same time
but if maximum effort is made it can be sustained

23

Effect on Bone
Exercise

Aging

Disuse

Exercise can
increase the forces
acting on the bone

Human skeleton
attains peak at 30
apprx.
In the following
decade bone mass
is stable and then
declines.

Disuse or
immobilization can
lead to changes in
bone geometry and
composition.

Few cycles of high

impact loading
(weight lifting) are
more effective for
increasing BMD
than repetitive
aerobic low impact
loading

By age of 90 women
have lost 20% of
cortical bone and 50
% of trabecular
bone.
For men, 5% of
cortical bone and 25
% of trabecular
bone.

Skeletal
degeneration and
calcium loss can
occur in space flight
due to reduced
loading

24

Effect on Articular cartilage

Exercise

Aging

Disuse

Repetitive loading or With age, cartilage

unloading can
becomes thinner.
produce swelling.
It looses water and
proteoglycan
content.

With immobilization,
cartilage will atrophy
and degenerate.

Chronic exercise
can produce large
number of extra
cellular matrix.
With extra loading
degradation
increases.

Amount of
proteoglycans
decrease and
cartilage is
compressed.
With immobilization,
cartilage will atrophy
and degenerate.

Collagen
concentration
increase.
When it is damaged,
there is remodelling
response.

25

Effect on Ligament
Exercise

Aging

Disuse

Increased structural
strength and stiffness.
Every day activity can
maintain 80-90% of
ligament's potential.
Exercise can increase
it by 10 %.

Aging increases
collagen
concentration and
reduces water in
ligaments.

Load deprivation
produces rapid
deterioration in
ligament's
biochemical and
mechanical
properties.

Trained ligament fail at

greater forces.
Physical, biochemical
and morphological
properties also
improves after
exercise for injured
ligament.

Insertion points of
ligaments
weakens and
viscosity declines.

It leads to loss in
strength and
stiffness.
Disuse increases
number of large
diameter fibrils and
decreases small
diameter fibrils.

26

Effect on Tendon
Exercise

Aging

Drugs

Increases number
and size of collagen
fibrils and the cross
sectional area of
tendon.

With age, as the

muscular strength
diminishes there is
a loss of strength
in the tendons
also.

Use of steroids to
enhance athletic
performance
decreses tendon
stiffness and
ultimate strength.

Growth and exercise

related stimuli may
conflict when growing
animals are
exercised.

Strength level
They impair the
tends to plateau till healing of injuries.
the age of 50,
followed by
decline in strength
that accelerates by
65.

27

Prescription
For a happy and healthy life
1 hour of exercise
7 hours of sleep
3 healthy meals /day
8 hours of hard work
Keep away from anger and accidents