**6. Conclusions**

The main characteristics of the aging of skeleto-neuro-muscular system at cellular and tissue level is overviewed in a holistic approach with the aim of giving a theoretical basis for physiotherapeutic interventions. The muscle fiber atrophy and numeric decline in the muscle fibers are associated with the fundamental alteration of the motor neurons and NMJ accompanied by the remodeling of motor units. The regeneration capacity of the muscle fibers is attenuated due to the intrinsic aging of the satellite cells and the self-renewal ability of stem cell pool. The aging of neuromuscular system (sarcopenia) is frequently associated with the aging processes in the bone (osteopenia). The blood supply to the skeletal muscle is also affected by the aging of microvasculature leading to decreased vasodilation and increased vasoconstriction responses.

The implementation and functional outputs of resistance and endurance training is overview in the mirror of current literature. It is generally accepted that the resistance training is the most important interventions in the elder age with taking into consideration the aging-dependent limitations. Feasibility and safety relations are also cited. The endurance training alone improves the cardiovascular fitness with lower (but not zero) direct impact on muscle power and performance. The combined training (AT+RT) completed with the elements of balance training seems to be the more effective in old people. The data about the effects of the physical exercises at cellular and tissue level offer good background to interpretation of the practical experiences.

Based on the current literature, we recommend the combined exercise trading, fundamentally based on resistance training but completed with the endurance and balance training elements.

### **Conflict of interest**

The authors declare no conflict of interest.

#### **Author details**

Boglárka Debity1 and Julianna Cseri<sup>2</sup> \*

1 University of Debrecen, UDAC Basketball Academy, Debrecen, Hungary

2 University of Debrecen, Department of Physiotherapy, Debrecen, Hungary

\*Address all correspondence to: cseri.julianna@gmail.com

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

**137**

ecc.12740.

*Effects of Physiotherapy Interventions on the Function of the Locomotor System in Elder Age…*

function and plasticity. J Muscle Res Cell Motil. 2019;40:127-140. https://doi. org/10.1007/s10974-019-09520-2.

[10] Hudlicka O: Microcirculation in skeletal muscle. Muscles Ligaments

[11] Lopez P, Pinto RS, Radaelli R, Rech A, Grazioli R, Izquierdo M, · Cadore LS: Benefits of resistance training in physically frail elderly: a systematic review. Aging Clin Exp Res. 2018;30(8):889-899. DOI: 10.1007/

[12] Xue QL: The frailty syndrome: definition and natural history. Clin Geriatr Med. 2011;27(1):1-15. DOI:

10.1016/j.cger.2010.08.009.

DOI: 10.1111/apha.12532.

cshperspect.a029785.

[13] Brook MS, Wilkinson DJ,

Phillips BE, Perez-Schindler J, Philp A, Smith K, Atherton PJ: Skeletal muscle homeostasis and plasticity in youth and ageing: impact of nutrition and exercise. Acta Physiol (Oxf). 2016;216(1):15-41.

[14] Distefano G, Goodpaster BH: Effects of Exercise and Aging on Skeletal Muscle. Cold Spring Harb Perspect Med. 2018;8(3): a029785. DOI: 10.1101/

[15] McCornick R, Vasilaki A: Agerelated changes in skeletal muscle: changes to life-style as a therapy. Biogerontology 2018;19:519-536. DOI:

Bamman MM, Zierath JR: Exercise Promotes Healthy Aging of Skeletal Muscle. Cell Metab. 2016;23(6):1034- 1047. DOI: 10.1016/j.cmet.2016.05.007.

10.1007/s10522-018-9775-3.

[16] Cartee GD, Hepple RT,

[17] Wilkinson DJ, Piasecki M, Atherton PJ: The age-related loss of skeletal muscle mass and function: Measurement and physiology of muscle

Tendons J. 2011; 1(1): 3-11.

s40520-017-0863-z.

*DOI: http://dx.doi.org/10.5772/intechopen.94239*

[1] Schiaffino S, Reggiani C: Fiber types in mammalian skeletal muscles. Physiol Rev. 2011;91(4):1447-531. DOI: 10.1152/

[2] Lepore E, Casola I, Dobrowolny G, Musarò A: Neuromuscular junction as an entity of nerve-muscle

communication. Cells. 2019;8(8): 906.

[4] Feige P, Brun CE, Ritso M, Rudnicki MA: Orienting muscle stem cells for regeneration in homeostasis, aging, and disease. Cell Stem Cell. 2018;23(5):653- 664. DOI: 10.1016/j.stem.2018.10.006.

[5] Greco EA, PietschmannP, Migliaccio S: Osteoporosis and Sarcopenia Increase Frailty Syndrome in the Elderly. Front Endocrinol (Lausanne). 2019;10: 255. DOI:10.3389/fendo.2019.00255.

[6] Sims NA, Vrahnas C: Regulation of cortical and trabecular bone mass by communication between osteoblasts, osteocytes and osteoclasts. Arch Biochem Biophys. 2014;561:22-8. DOI:

10.1016/j.abb.2014.05.015.

10.1155/2015/421746.

[7] Florencio-Silva R, Rodrigues da Silva Sasso G, Sasso-Cerri E, Simões MJ, Cerri PS: Biology of bone tissue: structure, function, and factors that influence bone cells. Biomed Res Int. 2015;2015:421746. DOI:

[8] Katsimbri P: The biology of normal bone remodelling. Eur J Cancer Care (Engl). 2017;26(6):e12740. DOI: 10.1111/

[9] Hendrickse, P, Degens H: The role of the microcirculation in muscle

DOI: 10.3390/cells8080906.

10.1002/cphy.c140068.

[3] Dumont NA, Bentzinger CF, Sincennes MC, Rudnicki MA: Satellite Cells and Skeletal Muscle Regeneration. Compr Physiol. 2015;5(3):1027-59. DOI:

physrev.00031.2010.

**References**

*Effects of Physiotherapy Interventions on the Function of the Locomotor System in Elder Age… DOI: http://dx.doi.org/10.5772/intechopen.94239*

## **References**

*Background and Management of Muscular Atrophy*

The main characteristics of the aging of skeleto-neuro-muscular system at cellular and tissue level is overviewed in a holistic approach with the aim of giving a theoretical basis for physiotherapeutic interventions. The muscle fiber atrophy and numeric decline in the muscle fibers are associated with the fundamental alteration of the motor neurons and NMJ accompanied by the remodeling of motor units. The regeneration capacity of the muscle fibers is attenuated due to the intrinsic aging of the satellite cells and the self-renewal ability of stem cell pool. The aging of neuromuscular system (sarcopenia) is frequently associated with the aging processes in the bone (osteopenia). The blood supply to the skeletal muscle is also affected by the aging of microvasculature leading to decreased vasodilation and increased

The implementation and functional outputs of resistance and endurance training is overview in the mirror of current literature. It is generally accepted that the resistance training is the most important interventions in the elder age with taking into consideration the aging-dependent limitations. Feasibility and safety relations are also cited. The endurance training alone improves the cardiovascular fitness with lower (but not zero) direct impact on muscle power and performance. The combined training (AT+RT) completed with the elements of balance training seems to be the more effective in old people. The data about the effects of the physical exercises at cellular and tissue level offer good background to interpretation of the

Based on the current literature, we recommend the combined exercise trading, fundamentally based on resistance training but completed with the endurance and

**6. Conclusions**

vasoconstriction responses.

practical experiences.

**Conflict of interest**

balance training elements.

**136**

**Author details**

Boglárka Debity1

and Julianna Cseri<sup>2</sup>

The authors declare no conflict of interest.

\*Address all correspondence to: cseri.julianna@gmail.com

provided the original work is properly cited.

\*

1 University of Debrecen, UDAC Basketball Academy, Debrecen, Hungary

2 University of Debrecen, Department of Physiotherapy, Debrecen, Hungary

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

[1] Schiaffino S, Reggiani C: Fiber types in mammalian skeletal muscles. Physiol Rev. 2011;91(4):1447-531. DOI: 10.1152/ physrev.00031.2010.

[2] Lepore E, Casola I, Dobrowolny G, Musarò A: Neuromuscular junction as an entity of nerve-muscle communication. Cells. 2019;8(8): 906. DOI: 10.3390/cells8080906.

[3] Dumont NA, Bentzinger CF, Sincennes MC, Rudnicki MA: Satellite Cells and Skeletal Muscle Regeneration. Compr Physiol. 2015;5(3):1027-59. DOI: 10.1002/cphy.c140068.

[4] Feige P, Brun CE, Ritso M, Rudnicki MA: Orienting muscle stem cells for regeneration in homeostasis, aging, and disease. Cell Stem Cell. 2018;23(5):653- 664. DOI: 10.1016/j.stem.2018.10.006.

[5] Greco EA, PietschmannP, Migliaccio S: Osteoporosis and Sarcopenia Increase Frailty Syndrome in the Elderly. Front Endocrinol (Lausanne). 2019;10: 255. DOI:10.3389/fendo.2019.00255.

[6] Sims NA, Vrahnas C: Regulation of cortical and trabecular bone mass by communication between osteoblasts, osteocytes and osteoclasts. Arch Biochem Biophys. 2014;561:22-8. DOI: 10.1016/j.abb.2014.05.015.

[7] Florencio-Silva R, Rodrigues da Silva Sasso G, Sasso-Cerri E, Simões MJ, Cerri PS: Biology of bone tissue: structure, function, and factors that influence bone cells. Biomed Res Int. 2015;2015:421746. DOI: 10.1155/2015/421746.

[8] Katsimbri P: The biology of normal bone remodelling. Eur J Cancer Care (Engl). 2017;26(6):e12740. DOI: 10.1111/ ecc.12740.

[9] Hendrickse, P, Degens H: The role of the microcirculation in muscle

function and plasticity. J Muscle Res Cell Motil. 2019;40:127-140. https://doi. org/10.1007/s10974-019-09520-2.

[10] Hudlicka O: Microcirculation in skeletal muscle. Muscles Ligaments Tendons J. 2011; 1(1): 3-11.

[11] Lopez P, Pinto RS, Radaelli R, Rech A, Grazioli R, Izquierdo M, · Cadore LS: Benefits of resistance training in physically frail elderly: a systematic review. Aging Clin Exp Res. 2018;30(8):889-899. DOI: 10.1007/ s40520-017-0863-z.

[12] Xue QL: The frailty syndrome: definition and natural history. Clin Geriatr Med. 2011;27(1):1-15. DOI: 10.1016/j.cger.2010.08.009.

[13] Brook MS, Wilkinson DJ, Phillips BE, Perez-Schindler J, Philp A, Smith K, Atherton PJ: Skeletal muscle homeostasis and plasticity in youth and ageing: impact of nutrition and exercise. Acta Physiol (Oxf). 2016;216(1):15-41. DOI: 10.1111/apha.12532.

[14] Distefano G, Goodpaster BH: Effects of Exercise and Aging on Skeletal Muscle. Cold Spring Harb Perspect Med. 2018;8(3): a029785. DOI: 10.1101/ cshperspect.a029785.

[15] McCornick R, Vasilaki A: Agerelated changes in skeletal muscle: changes to life-style as a therapy. Biogerontology 2018;19:519-536. DOI: 10.1007/s10522-018-9775-3.

[16] Cartee GD, Hepple RT, Bamman MM, Zierath JR: Exercise Promotes Healthy Aging of Skeletal Muscle. Cell Metab. 2016;23(6):1034- 1047. DOI: 10.1016/j.cmet.2016.05.007.

[17] Wilkinson DJ, Piasecki M, Atherton PJ: The age-related loss of skeletal muscle mass and function: Measurement and physiology of muscle fibre atrophy and muscle fibre loss in humans. Ageing Res Rev. 2018;47:123- 132. DOI: 10.1016/j.arr.2018.07.005.

[18] Yoo S-Z, No M-H, Heo JW, Park D-H, Kang J-H, Kim SH, Kwak H-B: Role of exercise in age-related sarcopenia. J Exerc. Rehabil. 2018;14(4):551-558. DOI: 10.12965/jer.1836268.134.

[19] Aagaard P, Suetta C, Caserotti P, Magnusson SP, Kjaer M: Role of the nervous system in sarcopenia and muscle atrophy with aging: strength training as a counter measure. Scand J Med Sci Sports 2010;20:49-64.

[20] Larsson L, Degens H, Li M, Salviati L, Lee YI, Thompson W, Kirkland JL, Sandri M: Sarcopenia: Aging-Related Loss of Muscle Mass and Function. Physiol Rev. 2019;99(1):427- 511. DOI: 10.1152/physrev.00061.2017.

[21] Sousa-Victor P, Muñoz-Cánoves P: Regenerative decline of stem cells in sarcopenia. Mol Aspects Med. 2016;50:109-17. DOI: 10.1016/j. mam.2016.02.002.

[22] Blau HM, Cosgrove BD, Ho ATV: The central role of muscle stem cells in regenerative failure with aging. Nat Med. 2015;21(8): 854-862. DOI: 10.1038/ nm.3918.

[23] Parker MH: The altered fate of aging satellite cells is determined by signaling and epigenetic changes. Front Genet. 2015;6: 59.

[24] Perandini LA, Chimin P, da Silva Lutkemeyer D, Olsen N, Câmara S: Chronic inflammation in skeletal muscle impairs satellite cells function during regeneration: can physical exercise restore the satellite cell niche? FEBS J. 2018;285(11):1973-1984. DOI: 10.1111/ febs.14417.

[25] Infante A, Rodríguez CI: Osteogenesis and aging: lessons from mesenchymal stem cells. Stem Cell

Res Ther. 2018;9(1):244. doi: 10.1186/ s13287-018-0995-x.

[26] Lai P, Song Q, Yang C, Li Z, Liu S, Liu B, Li M, Deng H, Cai D, Jin D, Liu A, Bai X: Loss of Rictor with aging in osteoblasts promotes age-related bone loss. Cell Death and Disease. 2016);7: e2408. DOI:10.1038/cddis.2016.249.

[27] Hemmatian H, Bakker AD, Klein-Nulend J, van Lenthe GH: Aging, Osteocytes, and Mechanotransduction. Curr Osteoporos Rep. 2017;15:401-411. DOI 10.1007/s11914-017-0402-z

[28] Jin K: A Microcirculatory Theory of Aging. Aging Dis. 2019;10(3): 676-683. DOI: 10.14336/AD.2019.0315.

[29] Dunford EC, Au JS, Devries MC, Phillips SM, MacDonald MJ: Cardiovascular aging and the microcirculation of skeletal muscle: using contrast-enhanced ultrasound. Am J Physiol Heart Circ Physiol 2018;315: H1194–H1199. DOI: 10.1152/ ajpheart.00737.2017.

[30] Hildebrandt W, Schwarzbach H, Pardun A, Hannemann L, Bogs B, König AM, Mahnken AH, Hildebrandt O, Koehler U, Kinscherf R: Age-related differences in skeletal muscle microvascular response to exercise as detected by contrastenhanced ultrasound (CEUS). PLoSONE 2017;12(3):e0172771. DOI:10.1371/journal. pone.017277.

[31] Tiggemann CL, Dias CP, Radaelli R, Massa JC, Bortoluzzi R, Wolf Schoenell MC, Noll M, Alberton CL, Martins Kruel LF: Effect of traditional resistance and power training using rated perceived exertion for enhancement of muscle strength, power, and functional performance. Age (Dordr). 2016;38(2):42. DOI: 10.1007/ s11357-016-9904-3.

[32] Mayer F, Scharhag-Rosenberger F, Carlsohn A, Cassel M, Müller S, Scharhag J: The Intensity and Effects of

**139**

*Effects of Physiotherapy Interventions on the Function of the Locomotor System in Elder Age…*

improves proxies of muscle strength, power and balance in healthy older adults: a randomised control trial. BMC Geriatr. 2016;16(1):191. DOI: 10.1186/

[40] Falck RS, Davis JC, Milosevic E, Liu-Ambrose T: How much will older adults exercise? A feasibility study of aerobic training combined with resistance training. Pilot Feasibility Stud. 2017;3:2. DOI: 10.1186/

[41] Sousa N, Mendes R, Silva A, Oliveira J: Combined exercise is more effective than aerobic exercise in the improvement of fall risk factors: a randomized controlled trial in community-dwelling older men. Clin Rehabil. 2017; 31(4):478-486. DOI:

10.1177/0269215516655857.

[42] Ferrari R, Fuchs SC, Kruel LF, Cadore EL, Alberton CL, Pinto RS, Radaelli R, Schoenell M, Izquierdo M, Tanaka H, Umpierre D: Effects of Different Concurrent Resistance and Aerobic Training Frequencies on Muscle Power and Muscle Quality in Trained Elderly Men: A Randomized Clinical Trial. Aging Dis. 2016;7(6):697-704. DOI:10.14336/AD.2016.0504.

[43] Gill TM, Pahor M , Guralnik JM , McDermott MM, King AC, Buford TW, Strotmeyer ES, Nelson ME, Sink KM, Demons JL, Kashaf SS, Walkup MP, Miller ME, LIFE Study Investigators: Effect of structured physical activity on prevention of serious fall injuries in adults aged 70-89: randomized clinical trial (LIFE Study). BMJ. 2016;352:i245.

[44] Hewitt J, Goodall S, Clemson L, Henwood T, Refshauge K: Progressive Resistance and Balance Training for Falls Prevention in Long-Term Residential Aged Care: A Cluster Randomized Trial of the Sunbeam Program. J Am Med Dir Assoc. 2018;19(4):361-369. DOI:

DOI: 10.1136/bmj.i245.

10.1016/j.jamda.2017.12.014.

s12877-016-0366-3.

s40814-016-0116-5.

*DOI: http://dx.doi.org/10.5772/intechopen.94239*

Strength Training in the Elderly. Dtsch Arztebl Int. 2011;108(21):359-364. DOI:

10.3238/arztebl.2011.0359.

[33] Steffl M, Bohannon RW, Sontakova L, Tufano JJ, Shiells K, Holmerova I: Relationship between sarcopenia and physical activity in older people: a systematic review and metaanalysis. Clin Interv Aging. 2017;12:835-

845. DOI: 10.2147/CIA.S132940.

[34] Straight CR, Lindheimer JB, Brady AO, Dishman RK, Evans EM: Effects of Resistance Training on Lower-Extremity Muscle Power in Middle-Aged and Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Sports Med. 2016;46(3):353-64. DOI: 10.1007/

[35] Borde R, Hortobágyi T, Granacher U: Dose-Response Relationships of Resistance Training in Healthy Old Adults: A Systematic Review and Meta-Analysis. Sports Med. 2015;45(12):1693- 720. DOI: 10.1007/s40279-015-0385-9.

[36] Westcott WL: Resistance training is medicine: effects of strength training on health. Curr Sports Med Rep. 2012;11(4):209-16. DOI: 10.1249/

[37] Geirsdottir OG, Arnarson A, Ramel A, Briem K, Jonsson PV, Thorsdottir I: Muscular strength and physical function in elderly adults 6-18 months after a 12-week resistance exercise program. Scand J Public Health 2014;43(1):76-82. DOI:10.1177/1403494814560842.

[38] Haider S, Grabovac I, Dorner TE: Effects of physical activity interventions

dwelling people. Wien Klin Wochenschr. 2019;131(11): 244-254. DOI: 10.1007/

in frail and prefrail community-

[39] Eckardt N: Lower-extremity resistance training on unstable surfaces

s00508-019-1484-7.

s40279-015-0418-4.

JSR.0b013e31825dabb8.

*Effects of Physiotherapy Interventions on the Function of the Locomotor System in Elder Age… DOI: http://dx.doi.org/10.5772/intechopen.94239*

Strength Training in the Elderly. Dtsch Arztebl Int. 2011;108(21):359-364. DOI: 10.3238/arztebl.2011.0359.

*Background and Management of Muscular Atrophy*

Res Ther. 2018;9(1):244. doi: 10.1186/

[26] Lai P, Song Q, Yang C, Li Z, Liu S, Liu B, Li M, Deng H, Cai D, Jin D, Liu A, Bai X: Loss of Rictor with aging in osteoblasts promotes age-related bone loss. Cell Death and Disease. 2016);7: e2408. DOI:10.1038/cddis.2016.249.

[27] Hemmatian H, Bakker AD, Klein-Nulend J, van Lenthe GH: Aging, Osteocytes, and Mechanotransduction. Curr Osteoporos Rep. 2017;15:401-411. DOI 10.1007/s11914-017-0402-z

[28] Jin K: A Microcirculatory Theory of Aging. Aging Dis. 2019;10(3): 676-683.

[29] Dunford EC, Au JS, Devries MC,

[30] Hildebrandt W, Schwarzbach H,

[31] Tiggemann CL, Dias CP, Radaelli R,

Schoenell MC, Noll M, Alberton CL, Martins Kruel LF: Effect of traditional

[32] Mayer F, Scharhag-Rosenberger F, Carlsohn A, Cassel M, Müller S, Scharhag J: The Intensity and Effects of

Massa JC, Bortoluzzi R, Wolf

resistance and power training using rated perceived exertion for enhancement of muscle strength, power, and functional performance. Age (Dordr). 2016;38(2):42. DOI: 10.1007/

s11357-016-9904-3.

Bogs B, König AM, Mahnken AH, Hildebrandt O, Koehler U, Kinscherf R: Age-related differences in skeletal muscle microvascular response to exercise as detected by contrastenhanced ultrasound (CEUS). PLoSONE 2017;12(3):e0172771. DOI:10.1371/journal. pone.017277.

DOI: 10.14336/AD.2019.0315.

Phillips SM, MacDonald MJ: Cardiovascular aging and the microcirculation of skeletal muscle: using contrast-enhanced ultrasound. Am J Physiol Heart Circ Physiol 2018;315: H1194–H1199. DOI: 10.1152/

ajpheart.00737.2017.

Pardun A, Hannemann L,

s13287-018-0995-x.

fibre atrophy and muscle fibre loss in humans. Ageing Res Rev. 2018;47:123- 132. DOI: 10.1016/j.arr.2018.07.005.

[18] Yoo S-Z, No M-H, Heo JW, Park D-H, Kang J-H, Kim SH, Kwak H-B: Role of exercise in age-related sarcopenia. J Exerc. Rehabil. 2018;14(4):551-558. DOI:

[19] Aagaard P, Suetta C, Caserotti P, Magnusson SP, Kjaer M: Role of the nervous system in sarcopenia and muscle atrophy with aging: strength training as a counter measure. Scand J

Med Sci Sports 2010;20:49-64.

[20] Larsson L, Degens H, Li M, Salviati L, Lee YI, Thompson W, Kirkland JL, Sandri M: Sarcopenia: Aging-Related Loss of Muscle Mass and Function. Physiol Rev. 2019;99(1):427- 511. DOI: 10.1152/physrev.00061.2017.

[21] Sousa-Victor P, Muñoz-Cánoves P: Regenerative decline of stem cells in sarcopenia. Mol Aspects Med. 2016;50:109-17. DOI: 10.1016/j.

[22] Blau HM, Cosgrove BD, Ho ATV: The central role of muscle stem cells in regenerative failure with aging. Nat Med. 2015;21(8): 854-862. DOI: 10.1038/

[23] Parker MH: The altered fate of aging satellite cells is determined by signaling and epigenetic changes. Front Genet.

[24] Perandini LA, Chimin P, da Silva Lutkemeyer D, Olsen N, Câmara S: Chronic inflammation in skeletal muscle impairs satellite cells function during regeneration: can physical exercise restore the satellite cell niche? FEBS J. 2018;285(11):1973-1984. DOI: 10.1111/

[25] Infante A, Rodríguez CI:

Osteogenesis and aging: lessons from mesenchymal stem cells. Stem Cell

mam.2016.02.002.

nm.3918.

2015;6: 59.

febs.14417.

10.12965/jer.1836268.134.

**138**

[33] Steffl M, Bohannon RW, Sontakova L, Tufano JJ, Shiells K, Holmerova I: Relationship between sarcopenia and physical activity in older people: a systematic review and metaanalysis. Clin Interv Aging. 2017;12:835- 845. DOI: 10.2147/CIA.S132940.

[34] Straight CR, Lindheimer JB, Brady AO, Dishman RK, Evans EM: Effects of Resistance Training on Lower-Extremity Muscle Power in Middle-Aged and Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Sports Med. 2016;46(3):353-64. DOI: 10.1007/ s40279-015-0418-4.

[35] Borde R, Hortobágyi T, Granacher U: Dose-Response Relationships of Resistance Training in Healthy Old Adults: A Systematic Review and Meta-Analysis. Sports Med. 2015;45(12):1693- 720. DOI: 10.1007/s40279-015-0385-9.

[36] Westcott WL: Resistance training is medicine: effects of strength training on health. Curr Sports Med Rep. 2012;11(4):209-16. DOI: 10.1249/ JSR.0b013e31825dabb8.

[37] Geirsdottir OG, Arnarson A, Ramel A, Briem K, Jonsson PV, Thorsdottir I: Muscular strength and physical function in elderly adults 6-18 months after a 12-week resistance exercise program. Scand J Public Health 2014;43(1):76-82. DOI:10.1177/1403494814560842.

[38] Haider S, Grabovac I, Dorner TE: Effects of physical activity interventions in frail and prefrail communitydwelling people. Wien Klin Wochenschr. 2019;131(11): 244-254. DOI: 10.1007/ s00508-019-1484-7.

[39] Eckardt N: Lower-extremity resistance training on unstable surfaces improves proxies of muscle strength, power and balance in healthy older adults: a randomised control trial. BMC Geriatr. 2016;16(1):191. DOI: 10.1186/ s12877-016-0366-3.

[40] Falck RS, Davis JC, Milosevic E, Liu-Ambrose T: How much will older adults exercise? A feasibility study of aerobic training combined with resistance training. Pilot Feasibility Stud. 2017;3:2. DOI: 10.1186/ s40814-016-0116-5.

[41] Sousa N, Mendes R, Silva A, Oliveira J: Combined exercise is more effective than aerobic exercise in the improvement of fall risk factors: a randomized controlled trial in community-dwelling older men. Clin Rehabil. 2017; 31(4):478-486. DOI: 10.1177/0269215516655857.

[42] Ferrari R, Fuchs SC, Kruel LF, Cadore EL, Alberton CL, Pinto RS, Radaelli R, Schoenell M, Izquierdo M, Tanaka H, Umpierre D: Effects of Different Concurrent Resistance and Aerobic Training Frequencies on Muscle Power and Muscle Quality in Trained Elderly Men: A Randomized Clinical Trial. Aging Dis. 2016;7(6):697-704. DOI:10.14336/AD.2016.0504.

[43] Gill TM, Pahor M , Guralnik JM , McDermott MM, King AC, Buford TW, Strotmeyer ES, Nelson ME, Sink KM, Demons JL, Kashaf SS, Walkup MP, Miller ME, LIFE Study Investigators: Effect of structured physical activity on prevention of serious fall injuries in adults aged 70-89: randomized clinical trial (LIFE Study). BMJ. 2016;352:i245. DOI: 10.1136/bmj.i245.

[44] Hewitt J, Goodall S, Clemson L, Henwood T, Refshauge K: Progressive Resistance and Balance Training for Falls Prevention in Long-Term Residential Aged Care: A Cluster Randomized Trial of the Sunbeam Program. J Am Med Dir Assoc. 2018;19(4):361-369. DOI: 10.1016/j.jamda.2017.12.014.

[45] Ubaida-Mohien C, Gonzalez-Freire M, Lyashkov A, Moaddel R, Chia CW, Simonsick EM, Sen R, Ferrucci L: Physical Activity Associated Proteomics of Skeletal Muscle: Being Physically Active in Daily Life May Protect Skeletal Muscle from Aging. Front Physiol. 2019;10:312. DOI: 10.3389/fphys.2019.00312.

[46] Franchi MV, Reeves ND, Narici MV: Skeletal Muscle Remodeling in Response to Eccentric vs. Concentric Loading: Morphological, Molecular, and Metabolic Adaptations. Front Physiol. 2017;8:447. DOI:10.3389/ fphys.2017.00447.

[47] Groennebaek T, Vissing K: Impact of resistance training on skeletal muscle mitochondrial biogenesis, content, and function. Front. Physiol. 2017;8:713. DOI: 10.3389/fphys.2017.00713.

[48] Zampieri S, Mosole S, Löfler S, Fruhmann H, Burggraf S, Cvečka J, Hamar D, Sedliak M, Tirptakova V, Šarabon N, Mayr W, Kern H: Physical Exercise in Aging: Nine Weeks of Leg Press or Electrical Stimulation Training in 70 Years Old Sedentary Elderly People. Eur J Transl Myol. 2015;25(4):237-42. DOI: 10.4081/ ejtm.2015.5374.

[49] Piasecki M, Ireland A, Piasecki J, Degens H, Stashuk DW, Swiecicka A, Rutter MK, Jones DA, McPhee JS: Long-Term Endurance and Power Training May Facilitate Motor Unit Size Expansion to Compensate for Declining Motor Unit Numbers in Older Age. Front Physiol. 2019;10:449. DOI: 10.3389/fphys.2019.00449.

[50] Button DC, Kalma JM: Understanding exercise-dependent plasticity of moto neurons using intracellular and intramuscular approaches. Appl Physiol Nutr Metab. 2019;44(11):1125-1133. DOI: 10.1139/ apnm-2018-0862.

[51] Hyldahl RD, Olson T, Welling T, Groscost L, Parcell AC: Satellite cell activity is differentially affected by contraction mode in human muscle following a work-matched bout of exercise. Front Physiol. 2014;5:485. DOI: 10.3389/fphys.2014.00485.

[52] Perandini LA, Chimin P, Lutkemeyer D, Câmara N: Chronic inflammation in skeletal muscle impairs satellite cells function during regeneration: can physical exercise restore the satellite cell niche? FEBS J. 2018;285(11):1973-1984. DOI: 10.1111/ febs.14417.

[53] Pugh JK, Faulkner SH, Turner MC, Nimmo MA: Satellite cell response to concurrent resistance exercise and high-intensity interval training in sedentary, overweight/obese, middleaged individuals. Eur J Appl Physiol. 2018;118(2): 225-238. DOI: 10.1007/ s00421-017-3721-y.

[54] Troy KL, Mancuso ME, Butler TA, Johnson JE: Exercise Early and Often: Effects of Physical Activity and Exercise on Women's Bone Health. Int J Environ Res Public Health. 2018;15(5):878. DOI: 10.3390/ijerph15050878.

[55] Pasqualini L, Ministrini S, Lombardini R, Bagaglia F, Paltriccia V, Pippi R, Collebrusco L, Reginato E, Sbroma Tomaro E, Marini E, D'Abbondanza M, Scarponi AM, De Feo P, Pirro M: Effects of a 3-month weight-bearing and resistance exercise training on circulating osteogenic cells and bone formation markers in postmenopausal women with low bone mass. Osteoporos Int. 2019;30(4):797- 806. DOI: 10.1007/s00198-019-04908-9.

[56] Wen HJ, Huang TH, Li TL, Chong PN, Ang BS: Effects of shortterm step aerobics exercise on bone metabolism and functional fitness in postmenopausal women with low bone mass. Osteoporos Int. 2017;28(2):539- 547. DOI: 10.1007/s00198-016-3759-4.

**141**

*Effects of Physiotherapy Interventions on the Function of the Locomotor System in Elder Age…*

*DOI: http://dx.doi.org/10.5772/intechopen.94239*

[58] Valenzuela PL, Morales JS, Pareja-Galeano H, Izquierdo, Emanuele E, de la Villa P, Lucia A: Physical strategies to prevent disuse-inducted functional decline int he elderly. Ageing Res Rev 2018; 47:80-88. DOI: 10.1016/j.

[57] Hearon Jr CM, Dinenno FA: Regulation of skeletal muscle blood flow during exercise in ageing humans. J Physiol. 2016;594(8): 2261-2273. DOI:

10.1113/JP270593.

arr.2018.07.003.

[59] Fragala MS, Cadore EL,

JSC.0000000000003230.

Dorgo S, Izquierdo M, Kraemer WJ, Peterson MD, Ryan ED: Resistance Training for Older Adults: Position Statement from the National Strength and Conditioning Association. J Strength Cond Res. 2019;33(8):2019-2052. DOI: 10.1519/

[60] Dent E, Morley JE, Cruz-Jentoft AJ, et al: International Clinical Practice Guidelines for Sarcopenia (ICFSR): Screening, Diagnosis and Management. J Nutr Health Aging. 2018;22(10):1148- 1161. doi:10.1007/s12603-018-1139-9

*Effects of Physiotherapy Interventions on the Function of the Locomotor System in Elder Age… DOI: http://dx.doi.org/10.5772/intechopen.94239*

[57] Hearon Jr CM, Dinenno FA: Regulation of skeletal muscle blood flow during exercise in ageing humans. J Physiol. 2016;594(8): 2261-2273. DOI: 10.1113/JP270593.

*Background and Management of Muscular Atrophy*

[51] Hyldahl RD, Olson T, Welling T, Groscost L, Parcell AC: Satellite cell activity is differentially affected by contraction mode in human muscle following a work-matched bout of exercise. Front Physiol. 2014;5:485. DOI:

10.3389/fphys.2014.00485.

[52] Perandini LA, Chimin P, Lutkemeyer D, Câmara N: Chronic inflammation in skeletal muscle impairs satellite cells function during regeneration: can physical exercise restore the satellite cell niche? FEBS J. 2018;285(11):1973-1984. DOI: 10.1111/

[53] Pugh JK, Faulkner SH, Turner MC, Nimmo MA: Satellite cell response to concurrent resistance exercise and high-intensity interval training in sedentary, overweight/obese, middleaged individuals. Eur J Appl Physiol. 2018;118(2): 225-238. DOI: 10.1007/

[54] Troy KL, Mancuso ME, Butler TA, Johnson JE: Exercise Early and Often: Effects of Physical Activity and Exercise on Women's Bone Health. Int J Environ Res Public Health. 2018;15(5):878. DOI:

Lombardini R, Bagaglia F, Paltriccia V, Pippi R, Collebrusco L, Reginato E, Sbroma Tomaro E, Marini E,

D'Abbondanza M, Scarponi AM, De Feo P, Pirro M: Effects of a 3-month weight-bearing and resistance exercise training on circulating osteogenic cells and bone formation markers in postmenopausal women with low bone mass. Osteoporos Int. 2019;30(4):797- 806. DOI: 10.1007/s00198-019-04908-9.

febs.14417.

s00421-017-3721-y.

10.3390/ijerph15050878.

[55] Pasqualini L, Ministrini S,

[56] Wen HJ, Huang TH, Li TL, Chong PN, Ang BS: Effects of shortterm step aerobics exercise on bone metabolism and functional fitness in postmenopausal women with low bone mass. Osteoporos Int. 2017;28(2):539- 547. DOI: 10.1007/s00198-016-3759-4.

[45] Ubaida-Mohien C, Gonzalez-Freire M, Lyashkov A, Moaddel R, Chia CW, Simonsick EM, Sen R, Ferrucci L: Physical Activity Associated Proteomics of Skeletal Muscle: Being Physically Active in Daily Life May Protect Skeletal Muscle from Aging. Front Physiol. 2019;10:312. DOI: 10.3389/fphys.2019.00312.

[46] Franchi MV, Reeves ND, Narici MV: Skeletal Muscle Remodeling in Response to Eccentric vs. Concentric Loading: Morphological, Molecular, and Metabolic Adaptations. Front Physiol. 2017;8:447. DOI:10.3389/

[47] Groennebaek T, Vissing K: Impact of resistance training on skeletal muscle mitochondrial biogenesis, content, and function. Front. Physiol. 2017;8:713. DOI: 10.3389/fphys.2017.00713.

[48] Zampieri S, Mosole S, Löfler S, Fruhmann H, Burggraf S, Cvečka J, Hamar D, Sedliak M, Tirptakova V, Šarabon N, Mayr W, Kern H: Physical Exercise in Aging: Nine Weeks of Leg Press or Electrical Stimulation Training in 70 Years Old Sedentary Elderly People. Eur J Transl Myol. 2015;25(4):237-42. DOI: 10.4081/

[49] Piasecki M, Ireland A, Piasecki J, Degens H, Stashuk DW, Swiecicka A, Rutter MK, Jones DA, McPhee JS: Long-Term Endurance and Power Training May Facilitate Motor Unit Size Expansion to Compensate for Declining Motor Unit Numbers in Older Age. Front Physiol. 2019;10:449. DOI:

10.3389/fphys.2019.00449.

[50] Button DC, Kalma JM:

apnm-2018-0862.

Understanding exercise-dependent plasticity of moto neurons using intracellular and intramuscular approaches. Appl Physiol Nutr Metab. 2019;44(11):1125-1133. DOI: 10.1139/

fphys.2017.00447.

ejtm.2015.5374.

**140**

[58] Valenzuela PL, Morales JS, Pareja-Galeano H, Izquierdo, Emanuele E, de la Villa P, Lucia A: Physical strategies to prevent disuse-inducted functional decline int he elderly. Ageing Res Rev 2018; 47:80-88. DOI: 10.1016/j. arr.2018.07.003.

[59] Fragala MS, Cadore EL, Dorgo S, Izquierdo M, Kraemer WJ, Peterson MD, Ryan ED: Resistance Training for Older Adults: Position Statement from the National Strength and Conditioning Association. J Strength Cond Res. 2019;33(8):2019-2052. DOI: 10.1519/ JSC.0000000000003230.

[60] Dent E, Morley JE, Cruz-Jentoft AJ, et al: International Clinical Practice Guidelines for Sarcopenia (ICFSR): Screening, Diagnosis and Management. J Nutr Health Aging. 2018;22(10):1148- 1161. doi:10.1007/s12603-018-1139-9

**143**

**Chapter 8**

*Viani Anggi*

muscular atrophy

**1. Introduction**

**Abstract**

Total Antioxidant from Herbal

Medicine as a Possible Tool for

Muscular Atrophy

the Multifunctional Prevention of

Muscular atrophy is one of disease by the loss of skeletal muscle mass. So, by the loss in muscle often causes rapid muscle atrophy and the occurs during injury and illness its causes immobilization in spinal muscle mass. Usually, the impact factor of the nervous system in musculoskeletal is caused by aging, immobility, malnutrition, medication and even the range of injuries disease impact by the nervous system. To meet the needs needed by the loss of skeletal, we need high total antioxidant from herbal medicine as multifunctional potentially prevention of muscular atrophy condition. Antioxidants are agents that can slow down or prevent oxidation process and protect cells system from the damage of cell by the loss skeletal in muscle mass. One of herbal medicine is *Abelmoschus manihot* L. Medik From Palu of central Sulawesi as a possible multifunctional prevention of Muscular Atrophy, where the total antioxidant value is 3,45 mg/mL.

**Keywords:** total antioxidant, herbal medicine, multifunctional prevention,

Muscular atrophy is one of disease by the loss of skeletal in muscle mass. The muscular atrophy recessive autosomal in neuromuscular with characterized of alpha motor neuron in the spinal cord [1]. The neuromuscular disorders are one factor genetic of infant mortality [2]. The spinal muscular atrophy deletion or mutation the Survival motor neuron 1 (SMN 1 gene), reduction of levels functional survival motor neuron 1 (SMN 1 gene) and also resulting selective death of spinal motor neurons system in a pathway, it's depends by the age of onset, symptoms and maximum function achieved [3]. By the age at the onset it causes at birth: Neuromuscular disease, congenital myotonic dystrophy and spinal muscular atrophy, other causes are systematic septicemia-induced disease, lung damage, intracranial pathologies, infection of the central nervous system, disorders of the peripheral nerves, disease of the neuromuscular junction, Prader-Willi syndrome and drug intoxication during pregnancy or delivery system and after 6 months of age were the neuromuscular disease: spinal muscular atrophy types II and III, polyneuropathies, childhood myasthenia gravis, muscular dystrophies and metabolic myopathy and besides that in other causes were congenital heart disease, malnutrition, rickets, metabolic diseases, nephropathies and lung diseases [4, 5]. The clinical prognosis of

### **Chapter 8**
