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Review
. 2024 Oct;109(10):1650-1662.
doi: 10.1113/EP091937. Epub 2024 Aug 6.

Mitigating disuse-induced skeletal muscle atrophy in ageing: Resistance exercise as a critical countermeasure

James McKendry  1 , Giulia Coletta  1 , Everson A Nunes  1 , Changhyun Lim  1 , Stuart M Phillips  1
Affiliations
Review

Mitigating disuse-induced skeletal muscle atrophy in ageing: Resistance exercise as a critical countermeasure

James McKendry et al. Exp Physiol. 2024 Oct.

Abstract

The gradual deterioration of physiological systems with ageing makes it difficult to maintain skeletal muscle mass (sarcopenia), at least partly due to the presence of 'anabolic resistance', resulting in muscle loss. Sarcopenia can be transiently but markedly accelerated through periods of muscle disuse-induced (i.e., unloading) atrophy due to reduced physical activity, sickness, immobilisation or hospitalisation. Periods of disuse are detrimental to older adults' overall quality of life and substantially increase their risk of falls, physical and social dependence, and early mortality. Disuse events induce skeletal muscle atrophy through various mechanisms, including anabolic resistance, inflammation, disturbed proteostasis and mitochondrial dysfunction, all of which tip the scales in favour of a negative net protein balance and subsequent muscle loss. Concerningly, recovery from disuse atrophy is more difficult for older adults than their younger counterparts. Resistance training (RT) is a potent anabolic stimulus that can robustly stimulate muscle protein synthesis and mitigate muscle losses in older adults when implemented before, during and following unloading. RT may take the form of traditional weightlifting-focused RT, bodyweight training and lower- and higher-load RT. When combined with sufficient dietary protein, RT can accelerate older adults' recovery from a disuse event, mitigate frailty and improve mobility; however, few older adults regularly participate in RT. A feasible and practical approach to improving the accessibility and acceptability of RT is through the use of resistance bands. Moving forward, RT must be prescribed to older adults to mitigate the negative consequences of disuse atrophy.

Keywords: anabolism; catabolism; muscle unloading; physical activity; sarcopenia.

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Conflict of interest statement

J.M., G.C., E.A.N and C.L. declare no conflicts of interest. S.M.P. reports grants or research contracts from the US National Dairy Council, Canadian Institutes for Health Research, Cargill, Friesland Campina, Dairy Farmers of Canada, Roquette Freres, Ontario Centre of Innovation, Nestle Health Sciences, Myos, National Science and Engineering Research Council, and the US NIH during the conduct of the study; personal fees from Nestle Health Sciences, non‐financial support from Enhanced Recovery, outside the submitted work. S.M.P. has patents licensed to Exerkine but reports no financial gains from patents or related work.

Figures

FIGURE 1
FIGURE 1
Schematic depiction of the consequences and mechanisms of ageing‐ and disuse‐induced skeletal muscle atrophy (Chen et al., ; Deane et al., ; Fix et al., ; Larsson et al., ; Paez et al., ; Spendiff et al., 2016). Created with BioRender.com.
FIGURE 2
FIGURE 2
Schematic representation of the changes in muscle mass (a) and protein turnover (b, c) with and without resistance training before, during and following resistance training (McGlory, von Allmen et al., ; Smeuninx et al., ; Suetta et al., 2009a). Created with BioRender.com.
FIGURE 3
FIGURE 3
Schematic representation of exercise training modalities following a period of muscle disuse to recover skeletal muscle mass, strength and function (e.g., gait speed) in older individuals (Bamman et al., ; Schroeder et al., ; Villareal et al., ; Willis et al., 2012). Created with BioRender.com.
See this image and copyright information in PMC

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