Get Strong, Stay Strong

Most people appreciate that being active is important for our health and wellbeing.

Many are also aware that to really get the health benefits from cardiovascular exercise we need to be getting our heart rate and respiratory rate up to a moderate or vigorous intensity for at least 150 or 75 minutes a week respectively.

What many people are unfamiliar with, however, is the importance of balance and strength training from cradle to grave.

Evidence suggests that there are strong associations in middle and older age between poor balance, poor strength or poor physical function and mortality, and that lower strength in late adolescence and early adulthood link with increased vascular risk in later life.

Given that surveys in the UK report that 69% of men and 76% of women are not meeting the strength and balance guidelines (two or more sessions a week), this has implications for us all.


How does strength and balance change across the lifecourse?

Muscle strength, bone strength and balance ability increase in childhood and peak in early adulthood. A decline in muscle mass is seen from around the age of 30 years but this is more notable from the age of 50 years (0.5-1% loss a year) and after 75 years (2-4%).

Low muscle strength, also known as sarcopenia, is linked with frailty. It is more common in older adults but can occur at any point due to lifestyle factors such as sedentary behaviour.

Studies have shown that there is approximately a 50% decline in muscle strength between 25 to 85 years. This loss of muscle strength is seen as the primary limiting factor for functional independence. We need that muscle strength to be able to get out of a chair, climb stairs and to have the capacity to maintain balance when we trip.

Women statistically have less muscle mass than men and so reach the fall threshold earlier with age related loss. Evidence shows, for example, that 25% of women are at risk of not being able to get up from a low chair independently between 70-74 years compared to 7% of men.

Similarly, obese individuals will have a lower muscle strength in lower limbs compared to body weight which impacts negatively on performance too.

Bone density peaks around 20-40 years. After that there is progressive loss, which is accelerated in women after the menopause. So building that bone strength when we are young is important, as is engaging in activities that maintain bone strength as we age.

Not surprisingly, balance also declines as we age and is often affected by many other factors such as obesity, reduced sensitivity of skin receptors, reduced cognitive processing, visual impairment, joint problems, pain, poor coordination and vestibular dysfunction.


When should we focus on strength and balance activity?

Research has shown that there are specific times in the life cycle where strength and balance activities would be most beneficial to health.

  • 18-24 years to maximise bone and muscle strength gains
  • 40-50 years to maintain strength and reduce that downward spiral
  • Over 65 years to preserve balance and maintain strength and independence

Of note, there are certain transition periods in life which have been identified as being important too. These transitions represent times in our lives when we might become less active and / or more sedentary. They include pregnancy, the menopause, following a diagnosis or medical condition ie stroke, on retirement, becoming a carer or following a period of hospitalisation or prolonged illness.

These periods can result in accelerated loss of strength, balance and cardiovascular fitness, and thus represent optimum times to instigate strength and balance training. Women might experience more of these life changes than men (pregnancy, menopause and becoming a carer) on top of the already statistically lower muscle mass.

What should we be doing and which activities help the best?

According to a review by Public Health England and the Centre for Ageing Better, we should be doing strength activities twice a week which include “high intensity resistance training, some impact exercise (running , jumping, skipping etc) and balance training.

The table below shows the positive impact of different types of activity on muscle, bone and strength outcomes.

Those with established osteoporosis, history of vertebral fractures or frailer older people with or without significant cognitive impairment need to seek advice from a physiotherapist as there are some activities that they should avoid and some that they should only do supervised.

Type of Sport, Physical Activity or ExerciseImprovement in Muscle FunctionImprovement in Bone HealthImprovement in Balance
RunningXXXX
Resistance TrainingXXXXXXXX
Circuit trainingXXXXXXXX
Ball GamesXXXXXXXX
Racquet SportsXXXXXXXX
Yoga, Tai ChiXXX
DanceXXXX
WalkingXX0
Nordic walkingXXNKXX
CyclingXXX

XXX= Strong Effect; XX=Medium Effect; X= Low; 0= no effect; NK=Not Known

Assessment of the positive impact of different types of sport, physical activity or exercise on muscle, bone and balance outcomes (adapted from Heinonen & Kujala in Kokko et al 2011)

There are clearly many other activities not listed on the table such as swimming, skiing/snowboarding, hillwalking, climbing and martial arts other than tai chi that will improve muscle and bone strength and balance.

The important aspect, according to Health Survey England is that the effort of the activity is enough that “the muscles feel some tension, shake or feel warm” and ideally for this to be sustained for bouts of at least 10 minutes. With this is mind, many everyday activities could fall into strength and balance work such as climbing stairs, gardening and DIY. They don’t necessarily have to be planned extras. So this makes it easier when thinking of how we can integrate it into our ever busy schedules.


As you can see, getting strong and staying strong is important across the lifecourse and especially at particular periods of change, yet many of us are not doing enough. So how could we tackle this and start doing more?

First, we need to consider where we are currently and where we would like to be. We then need to break down our goals into realistic and achievable steps. #OneChange is a fun way to do this. It is about nudging or coaxing us to change our behaviour or to start a new healthy habit. An effective and simple way to do this can be to anchor the new habit with a current activity such as boiling the kettle or brushing your teeth.

So to kickstart this, my #OneChange is to stand on one leg whilst brushing my teeth.

What is yours?!

References

  1. “How do muscle and bone strengthening activities (MBSBA) vary across the lifecourse and are there particular ages where MBSBA are most important?” Dawn Skelton, Alexandra Manroeidi Journal of Frailty, Sarcopenia and Falls / June 2018 / Vol 3 No.2 / 74-84
  2. “What types of physical activities are effective in developing muscle and bone strength and balance? Charlie Foster, Miranda E.G Armstrong. Journal of Frailty, Sarcopenia and Falls / June 2018 / Vol 3 No 2 / 58-65
  3. Muscle and bone strengthening and balance activities for general health benefits for adults and older adults. Summary of a rapid evidence review of the UK Chief Medical Officer’s update of the physical activity guidelines. PHE and Centre for Ageing Better. July 2018.
  4. Health Survey for England 2016. Physical Activity in adults. NHS Digital.

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