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GERONTOLOGY AND COMMUNICATION DISORDERS

Topic :
PHYSICAL CHANGES AND PERFORMANCE – RANGE OF
MOTION ,STRENGTH ,ENDURANCE , PRAXIS , PERFORMANCE WORK

Submitted by :
Dhruvan Mahesh
Prince Srivatsav
Shilpa V
Sooraj P C
First Msc.SLP
ALL INDIA INSTITUTE OF SPEECH AND HEARING

Submitted to :
Dr Goswami
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 Aging is the process that occurs in living organisms with the passage of time. In
general, the body undergoes physiological changes in the musculoskeletal system,
such as a decrease in muscle strength, muscle endurance, flexibility, and balance as
well as functional changes in cardiorespiratory endurance. These changes lead to a
loss of adaptability and an increase in functional impairment , which increase the risk
of falls in the elderly .

 Ageing in humans refers to a multidimensional process of physical, psychological,

and social change.

 The World Health Organization (WHO) defines aging as a “process of progressive

change in the biological, psychological and social structure of individuals”

 Aging is an inevitable progressive deterioration of physiological function with

increasing age, demographically characterized by an age – dependent increase in
mortality and decline of fecundity (Rose 1991, Bronikowksi & Flatt 2010)

 It is well known that the aging process is accompanied by a gradual and sustained loss
of physical abilities (Lima, Rodrigues, Bezerra, Rodrigues, & Cancela, 2020). In this
sense, muscle size and muscle power show a significant decrease in aged adults
(Keller & Engelhardt, 2013).

 This progressive muscle weakening has important consequences for daily living
activities such as walking, standing and sitting on a chair affecting directly the
dynamic balance and increasing the risk of falling and morbidity (Alcazar et al., 2020;
Benavent-Caballer et al., 2016; Bernardi et al., 2004; Bisciotti, Bisciotti, & Bisciotti,
2022) and health care costs.

 It has been published that this reduction of physical capabilities shows an important
acceleration in the 6th decade of life and reach up to a 2-3% loss per year in healthy
adults (Ikezoe, Mori, Nakamura, & Ichihashi, 2011)

 Motor performance declines with advanced age and is accelerated in very old age
(>80 yr), involving muscles that are weaker, slower, less powerful, less steady, and
more fatigable during high-velocity dynamic tasks

 Range of motion
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 When a joint does not move fully and easily in its normal manner it is considered to
have a limited range of motion. With increased aging, range of motion will be
reduced. Most people lose some range of motion as they get older.

 Range of motion (ROM) refers to the ability of a joint to move through its natural
pattern of movement. For example, the shoulder of a typical healthy person can Alex
up (toward the sky) nearly straight (about 170%; Soucie et al., 2011). This amount of
movement is considered normal for that joint. Every joint in the body has a typical
range.

 Declines in joint ROM in the shoulder, hip, and wrist are known to occur with age, up
to 5–6 degrees per decade after age 55 (Stathokostas, McDonald, Little, & Paterson,
2013)

 Chronological age alone is not as likely to affect ROM as much as some age-related
conditions, which can restrict smooth movements and limit maximum ROM.

 Specifically, arthritis; joint or muscle disuse, misuse, or overuse; injuries; stroke;

Parkinson’s disease; and dementia are associated with less than optimal movement
patterns.

 Often older adults do not know how much range of motion they’ve lost until it is hard
to do things like walk, shower, get dressed, or cook.

 Arthritis is the most common cause of disability in the United States, with more than
50 million people (approximately 50% of adults over age 65) living with the
functional limitations and losses associated with its various forms (CDC, 2012).

 Nonresistive, repetitive ROM exercises can be useful in maintaining or improving

current range of movement, or may slow down the progression of disease processes as
in the case of osteoarthritis (Mayo Clinic, 2016).

 Contractures are generally caused by joint immobilization and result in decreased

ROM, stiffening and subsequent structural changes, and pain upon movement at one
or more joints. The joints typically affected are the hips, shoulders, fingers, and knees.

 The best treatment approach is to prevent contractures from occurring through regular
movement and exercise/stretching. However, if remedial treatment is needed, the
focus of intervention is to increase joint mobility through the use of a passive, active-
assisted, or an active ROM program established by a rehabilitation specialist.
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 If contractures are not resolved, surgical intervention may be required to reduce pain
or immobility that is interrupting daily functioning (e.g., bathing, dressing, and
eating).

 Strength
 Lexell J (1988), muscle mass and strength tend to reduce by 30%–50% between the
ages of 30 and 80 years, with the main cause the reduction in the number of muscle
fibers and atrophy of type II muscle fiber.

 The age-related reduction in maximal isometric strength largely parallels the loss
of muscle mass (Metter et al, 1999).

∼10% per decade with reductions starting at approximately 40–50 yr of age, with
 Based on cross- sectional studies of lower limb muscles, strength is usually reduced

yr-old can be ∼40% that of a same-sex 20- to 30-yr-old (Hunter et al, 2000).
evidence of accelerated declines in very old age so that the average strength of an 80-

 Lower specific force (force per unit cross-sectional area) of limb muscles in old adults
is explained in part by greater infiltration of fat and connective tissue that may
beameliorated with physical activity (Goodpaster et al, 2008).

 Loss of muscle fibers reduces strength capacities, decreases muscle metabolism and
increase risk of muscle damage (Zatsiorsky VM, Kreamer WJ, 2008).

 The decline of hormonal synthesis leads to distinct changes in human body with
decreasing muscle mass and strength (Zatsiorsky VM, Kreamer WJ,2008).

 Muscle repair capacities are reduced with increased age (Raggi C, Berardi AC,2012).

 Maximum muscle strength tends to occur in early adulthood; middle age is generally
a time of only slight decline. After age 50, there is a reduction in strength, with losses
tending to occur at a 15% loss in strength every 10 years (Keller & Engelhardt, 2013).

 The strength of both tendons and ligaments decreases with age and shows decrease in
water content .These changes also contribute to decreased strength and mobility in the
skeletal system.( Tabloski,2014)
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 The limited number of longitudinal studies indicate the variability between

individuals and the rate of strength reduction is greater with increasing age, possibly
more so in men and with chronic disease in old adults.

 Furthermore, there can also be variability in strength between muscles with advanced
age because the age-related reductions in isometric strength are typically greater in
muscles of the lower limb such as the knee extensors than for the upper limb such as
the finger flexor and elbow flexor muscles. This muscle group difference may be
explained in part by the variability in the rate of sarcopenia in response to differing
use of muscles groups between the limbs (Hunter et al, 2016).

 Maximal torque during isokinetic dynamic contractions is also reduced with

advanced age in both men and women. At fast speeds of shortening (concentric)
contractions, the age- related reduction in maximal torque for some muscles such as
the knee extensor muscles is larger than for slower speeds, and this difference can
vary across muscle groups (Hunter et al, 2016).

 According to the study by Milanović, Z., 2013, it has been shown that upper-limb
strength decreases with the aging process for both elderly men and women. This study
found the average reduction in muscle strength to be approximately 1% annually for
both men and women.

 Muscle-strength loss has been shown to be greater for lower limbs in comparison to
upper limbs, it is also likely to be a consequence of more physical inactivity.

 Older (70–80 years) people were less physically active in all segments (work-related,
transportation, housework/gardening, and leisure-time activity) compared to the
younger (60–69) ones, which would have an impact on muscle-strength loss.

 Studies have shown that older adults who exercise can reduce the pain caused by
arthritis, restore balance to reduce fall potential, strengthen bones, maintain weight,
improve glucose control for diabetes management, and improve heart health.

 Also, by adding a prescribed exercise routine, people can improve their muscle
strength and may even get strong enough to participate in the Senior Olympics and
win competitions.

 Encouraging physical activity is almost always appropriate, although the level of

exertion and duration of activity need to be determined by the person’s primary
healthcare provider(s).
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 Endurance
 Falls are the accident that usually occurs in older people, which increase morbidity
and premature mortality among aging adults 65 years and older . Therefore, it is
important to prepare for the aging process by increasing the physical activity of older
adults to promote health and quality of life.

 Endurance is usually defined as the ability to sustain involvement in a physical

activity.

 The combination of endurance and strength training has been found to have a positive
impact on heart and pulmonary function, improve muscle function, increase
functional capacity, and improve cognition (Muscari et al., 2010; National Institutes
of Health, 2012)

 Lack of this physical reserve and ability to resist stressors can lead to frailty (Cadore,
Pinto, Bottaro, & Izquierdo, 2014). Although not the same as strength, the two are
closely intertwined. As muscle power decreases, frailty level increases (Cadore et al.,
2014).

Physical Exercise

 A meta-analysis of 13 aerobic exercise training programs for older adults

demonstrated that long-term programs (more than 30 weeks in duration) were
associated with improved physical endurance (Huang, Shi, Davis-Brezette, & Osness,
2005).

 An active lifestyle involving stretching, aerobic activity, and strength building can
improve ROM, strength, and endurance. Participation in such a program may actually
slow the course of physiologic aging.

 Curlik and Shors (2013) found that physical exercise in rodents helped to build new
brain cells, and therefore was also important for maintaining brain health. Even
though aerobic activity fosters the production of new neurons in the hippocampus, it
is brain activity associated with learning new skills (e.g., cognitive exercise) that
helps the newly formed neurons survive over time (at least in the rodent models).

 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
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 Praxis
 Praxis is defined as the ability to carry out purposeful motor actions. Dyspraxia refers
to a decreased ability to plan and/or execute purposeful movements, whereas Apraxia
refers to the complete inability to carry out these motor plans.

 During most common everyday routines, most people do not need to think
consciously about their performance; simple tasks (such as eating or dressing) are
completed automatically. Repetition of these routines over time allows the conversion
of initially novel actions into established habits.

 Goal-directed actions occur throughout the day during self-care, work, leisure, and
home management tasks.

 Functional performance is not lost rapidly or suddenly one day because of the aging
process.

 If the level of motor (or cognitive) performance significantly decreases for any reason
(e.g., injury, aging, or disease), one’s ability to live independently can be threatened.

Physical Performance

Genetics, lifestyle, and the presence of illness or disease can impact the onset and
severity of change in physical performance.

 Age-related performance has been measured in several domains:

- reaction time, gross motor coordination (including balance and
mobility), strength, endurance, and work-related performance.

o Reaction Time:

 The most straightforward trend when examining performance is the slowing of

reaction time as people head into old age. One example of a situation when a quick
reaction time is needed is while driving a car and suddenly needing to yield or brake
in traffic.

 As people age, they are not able to react as quickly as they were in their younger
years. Sventina (2016) found that reaction time and timed performance do slow
significantly with age.

o Motor Coordination:
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 Intact gross motor coordination (i.e., mobility or ambulation) is another crucial

prerequisite to completing daily tasks without assistance.

 Falls affect older adults more than any other age group. An estimated one in three
adults age 65 and older has at least one fall yearly. Of these 2.3 million falls, more
than 800,000 resulted in hospitalization as a result of head injuries and hip fractures
(CDC, 2017).

 Between 20% and 30% of people who fall sustain injuries such as lacerations, hip
fractures, or head traumas. Injuries from falls can make it hard to ambulate or live
independently, and increase the risk of early death (CDC, 2017). In 2014, over 55,000
older adults died as a result of an unintentional fall (CDC, 2017).

 Repeated falls are often associated with declines in balance, coordination, and/or
strength, all of which have been well researched and determined to be correlated with
increased age.

 There are several ways to improve postural control (i.e., exercises, sports, yoga, or tai
chi) to limit the number of potential falls, by challenging balance and improving
strength and agility (Gillespie et al., 2006).

 Fine motor coordination refers to hand-based skills such as writing, self-feeding,

buttoning, and working with tools. When fine motor skills are impaired, as they often
are in old age, the culprit is more than likely arthritis, stroke, or another skill robbing
disease rather than typical aging.

 Older adults who age typically without limitations brought on by disease are just as
capable as their younger counterparts in completing fine motor tasks such as typing,
cooking, knitting, and card playing.

 This maintenance of motor skills has two potential explanations:

(1) consistent practice over the years has maintained and/or improved skill level
over time
(2) with ongoing repetition these tasks become more automatic and therefore
require less skill for completion.

 Older adults show deficits in coordination of bimanual and

multi-joint movements. For example, movements become slower
and less smooth when older adults move their shoulder and elbow
joints simultaneously as opposed to performing single joint actions
(Seidler et al., 2002).
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 Research with deafferented patients has demonstrated that

proprioception is critical to controlling the timing of such multi-joint
actions (Sainburg et al., 1995). Cerebellar patients exhibit similar
deficits (Bastian et al., 1996), suggesting that age-related
degeneration of the cerebellum (Raz, et al., 2001; 2005) and
the proprioceptive system (cf. Goble et al., 2009) may contribute
to deficits in multi-joint coordination for older adults.

 During bimanual tasks older adults demonstrate performance

deficits in both temporal (Wishart et al., 2000) and spatial
coordination (Stelmach et al., 1988) in comparison to young
adults. Considerable evidence suggests that temporal bimanual
coordination is most stable when movements are performed
either in-phase or anti-phase (Kelso, 1984). Young and older
adults perform almost identically during in-phase bimanual
movements across a range of frequencies. However, older adults
exhibit greater movement variability than their younger
counterparts during anti-phase movements at increasing
frequencies (Wishart et al., 2000).

 Work performance
 In considering age-related losses in functioning with regard to cognition, balance,
reaction time, and muscle strength, one might surmise that general work
performance of older workers would be inferior to that of their younger
counterparts. However, this does not seem to be the case.

 Having health issues and being older does not significantly interfere with the
quality of work.

 Older adults are considered more dependable (Prenda & Stahl, 2001; Reade,
2015), are less likely to be absent from work, and have fewer proportionately
workplace injuries than younger workers (Ng & Feldman, 2008).

 They also demonstrate less workplace aggression and substance misuse than their
younger counterparts (Prenda & Stahl, 2001; Reade, 2015).

 Although there do seem to be age-related declines in cognition, sensation,

perception, and physical performance, for most typically aging older adults these
changes do not make a substantial impact on either their comprehensive work
performance or essential daily living skills.

 Most older adults can do very well in the workplace with minimal modifications
for their health and safety (e.g., changes in workstation setup, improved lighting).
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These accommodations can also benefit younger workers (Kenny, Yardley,

Martineau, & Jay, 2008).

ARTICLE

EFFECT OF THE COVID-19 EPIDEMIC ON PHYSICAL ACTIVITY IN

COMMUNITY-DWELLING OLDER ADULTS IN JAPAN: A CROSS-SECTIONAL
ONLINE SURVEY

Yamada.M , Kimura.Y , D. Ishiyama , Y. Otobe , M. Suzuki , S. Koyama , T. Kikuchi , H.

Kusumi , H. Arai (2020) . Effect of the covid-19 epidemic on physical activity in community
-dwelling older adults in Japan: a cross-sectional online survey. The journal of
nutrition,health and aging;24(9):948-950

Objectives:

The objective of this study was to investigate changes in physical activity (PA) between
January (before the COVID-19 epidemic) and April (during the COVID-19 epidemic) 2020
in communitydwelling older adults in Japan.

Design:

Cross-sectional online survey.

Setting and Subjects:

From April 23 to 27, 2020, an online survey was completed by 1,600 community-dwelling
older adults in Japan.

Methods:

We assessed the frailty status using the Kihon checklist, and other demographics and asked
questions regarding PA at two time points: January and April 2020. We defined the total PA
time (minutes) per week based on activity frequency and time.

Results:

The study participants’ mean age, proportion of women, and prevalence of frailty were
74.0±5.6 years, 50% (n=800), and 24.3% (n=388), respectively. We found a significant
decrease in total PA time in April 2020 (median [interquartile range (IQR)], 180 [0 to 420])
when compared to January 2020 (median [IQR], 245 [90 to 480]) (P<0.001). We also
performed a subgroup analysis according to the frailty category; total PA time significantly
decreased in April 2020 when compared to January 2020 for all frailty cateSries (P<0.001).

Conclusion:
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In conclusion, due to the COVID-19 epidemic, the total PA time in April 2020 significantly
decreased compared to that in January 2020 in older adults. This finding may lead to a higher
incidence of disability in the near future in older people.

Reference:
 Carmen Ferragut, Helena Vila Suarez, Miguel Lima, Luis Paulo Rodrigues,Pedro
Bezerra,José María Cancela(2023) .Age-dependent changes in physical performance
in community dwelling elderly women. A crosssectional study.
DOI: 10.47197/retos.v48.97070

 Hunter, S. K., Pereira, H. M., & Keenan, K. G. (2016). Aging and

Exercise: The aging neuromuscular system and motor performance.
Journal of Applied Physiology, 121(4), 982-995.
https://doi.org/10.1152/japplphysiol.00475.2016
 Robnett, R. H., & Chop, W. C. (2013). Gerontology for the health care professional.
Jones & Bartlett Publishers.
 Miller, R. M., Freitas, E. D., Heishman, A. D., Peak, K. M., Buchanan, S. R.,
Kellawan, J. M., ... & Bemben, M. G. (2021). Muscle performance changes with age
in active women. International journal of environmental research and public
health, 18(9), 4477.
 Milanović, Z., Pantelić, S., Trajković, N., Sporiš, G., Kostić, R., & James, N. (2013).
Age-related decrease in physical activity and functional fitness among elderly men
and women. Clinical interventions in aging, 8, 549.
 Richard W. Besdine (2008). Physical Changes with Aging.
 Physical Change & Aging A Guide for the Helping Professions ( Seventh
edition ) ,Sue V. Saxon ,Mary Jean Etten, Elizabeth A. Perkins