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Nutrition 411: Exercising to Improve Body Composition
Dr. Collins will be speaking in-depth about body composition and demonstrating how to measure it at the Symposium on Advanced Wound Care, San Antonio, TX, May 2, 2015.
An estimated 42% of people over the age of 65 have limitations in performing one or more daily tasks that are essential for independence, such as walking a few blocks and transferring from sitting to standing.1 Although such limitations have many causes, it is well established that low levels of voluntary muscle strength and power are contributing factors associated with age-related physical disability.1 This lack of strength makes grocery shopping, meal preparation, and clean-up difficult. The loss of muscle strength is a great concern for our aging population because it affects quality of life; it also may determine whether an individual is safe to remain in his/her own home or should move into a living arrangement with caregivers.
Age-related muscle atrophy begins in the third decade of life and accelerates with advancing age. Ask anyone over 40 years old if his/her body has changed —almost everyone will reply with a resounding “Yes.” Sarcopenia, from the Greek, meaning poverty of flesh, is the degenerative loss of skeletal muscle mass and strength associated with aging.2 It is a component of the frailty syndrome and can be debilitating and even fatal for the elderly, especially in the presence of other comorbidities, including chronic wounds. The root of the sarcopenia problem is the issue of body composition.
Lean and Fat Tissues
The term body composition is used to describe the different components of the body that make up a person’s total body weight or the relative proportions of fat, bone, and muscle mass. Models that characterize human body composition using 2, 3, or 4 components have been proposed. However, the 2-compartment model, which partitions body mass into fat mass and fat-free mass (FFM), has the widest application to body composition analysis in most settings.3 Although the relative compartment sizes are influenced by genetics, age, gender, and ethnicity, the absolute compartment sizes are influenced by lifestyle and environment. For example, if an individual consumes more calories (energy) than the body utilizes each day for basic metabolic processes and physical activity, the excess will be stored as fat mass, and this compartment will grow in size.
In the 2-compartment model, FFM is “lean tissue,” which includes water, muscle, bone, connective tissue, and internal organs. FFM is metabolically active — it does the work of the body. Another commonly used term is lean body mass (LBM), which is FFM plus essential fat (fat needed for normal physiological functioning).4 The size of the lean tissue component is regulated by various metabolic pathways. A loss of lean tissue along with negative nitrogen balance, which is typically observed in critical illness to meet increased energy demands, usually represents a loss of functioning proteins and amino acids. This scenario is detrimental to health and well-being because it can lead to the impaired function of multiple organs.5 This same negative nitrogen balance often occurs in patients with chronic wounds.
Importance of Resistance Training for Older Adults
Experts have recommended daily physical activity or exercise, including resistance or strength training, should be undertaken by all older people for as long as possible.6 Aging and inactivity are associated with loss of muscle mass primarily due to decreased muscle protein synthesis. However, aging muscle does respond to resistance exercise, which leads to gains in muscle mass and strength, thus improving physical function and promoting anabolism. Resistance training can also help attenuate the effects of sarcopenic obesity by limiting skeletal muscle loss during periods of restricted energy intake.6 Adults with venous leg ulcers also may experience decreased mobility. However, a recent study7 demonstrated that a 12-week exercise program that included lower-limb resistance training resulted in improvements in calf muscle pump function and range of ankle motion compared to usual care.
Although the evidence is clear that exercise, and particularly resistance exercise, offers many benefits, patients often do not know how to begin or feel they cannot partake because of limited mobility. A simple exercise program that requires only light dumbbells is described below in 2 versions — 1 for patients to do while in bed and 1 for patients to do standing (see Table 1). Several of the exercises can be modified to be performed in a chair. Encourage your patients to start out slowly and perhaps aim to perform only 1 or 2 of the exercises each day. As strength returns, more exercises can be added to the daily routine.
Practice Points
Health care providers must constantly be aware of the effects of illness, wounds, and inactivity on body composition, especially in the elderly, and take proactive steps to minimize damage and erosion of the metabolically active tissues. This includes screening every patient and stressing independent functioning as the reward for proper diet and exercise. Adequate protein substrate must be consumed at every meal to maximize protein synthesis. Progressive resistance exercise, which can be as simple as the exercises described, also can help stimulate anabolism and protect LBM. With this formula, we can ward off frailty and have happier patients who can do more for themselves… and then everyone wins!
Nancy Collins, PhD, RDN, LD, FAPWCA, FAND is a registered dietitian and founder/clinical editor of Nutrition411.com. For the past 25 years, she has served as a consultant to health care institutions and is a medico-legal expert for law firms involved in health care litigation. Dr. Harris is an Associate Professor in the Department of Nutrition and Exercise Science and Program Director of the graduate-level Didactic Program in Dietetics at Bastyr University (Kenmore, WA). She is also the owner of Aim 2 Nourish LLC, offering consulting services and nutrition counseling for athletes and/or individuals with eating disorders. Correspondence may be sent to Dr. Collins at NCtheRD@aol.com. This article was not subject to the Ostomy Wound Management peer-review process.
1. Russ DW, Gregg-Cornell K, Conaway MJ, Clark BC. Evolving concepts on the age-related changes in “muscle quality.” J Cachexia Sarcopenia Muscle [serial online]. 2012;3(2):95–109. Available at: www.springerlink.com/content/u400w8658h7711j7/fulltext.pdf?MUD=MP. Accessed March 14, 2015.
2. Paddon-Jones D. Lean body mass loss with age. Available at: http://images.abbottnutrition.com/ANHI2010/MEDIA/14-110th%20AN%20Conf%20Paddon-Jones%20Final.pdf. Accessed March 15, 2015.
3. Ratamess N. Body composition status and assessment. In: Ehrman JK, DeJong A, Sanderson B, Swain D, Swank A, Womack C eds. ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription, 6th ed. Baltimore, MD: Lippincott, Williams & Wilkins;2010:264.
4. Bouchard C. Body composition assessment. In: McKardle WD, Katch FI, Katch VL, eds. Exercise Physiology: Energy, Nutrition, and Human Performance, 7th ed. Baltimore, MD: Lippincott, Williams & Wilkins;2010:725–793.
5. Weitzel LRB, Sandoval PA, Mayles J, Wischmeyer PE. Performance-enhancing sports supplements: role in critical care. Crit Care Med. 2009;37(10 suppl):S400–S409.
6. Deutz NEP, Bauer JM, Barazzoni R, Biolo G, Boirie Y, Bosy-Westphal A, et al. Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group. Clin Nutr. 2014;33(6):929–936.
7. O’Brien J, Edwards H, Stewart I, Gibbs H. A home-based progressive resistance exercise programme for patients with venous leg ulcers: a feasibility study. Int Wound J. 2013;10(4):389–396.
