Keeping active to prevent musculoskeletal ageing?

Article taken from Arthritis Today | Summer 2015 | No 168

We’re all familiar with the idea that keeping active is good for us, particularly as we age. However, few older people do much exercise. And now researchers at our two musculoskeletal ageing centres are becoming increasingly aware of exactly how damaging a sedentary lifestyle can be for our bones, muscles and joints. They’re uncovering evidence that a large proportion of what we call ageing may in fact be due to inactivity.

When it comes to the idea of exercising and keeping active, for most people the thought that springs to mind is donning the Lycra and hitting the gym. However, being physically active is not just about hopping on the treadmill – just getting up and walking around every so often is good for us as well. 

In fact, something as simple as walking is seen as increasingly important (see the linked feature Walking back to fitness).

Sir Muir Grey, one of the UK’s most senior medical figures, and a former advisor to the NHS, believes it’s important to talk about a ‘healthspan’ rather than a lifespan, and says that many of the problems associated with old age could be solved if people over 70 were better at keeping fit. Sir Muir, who has written a book extolling the importance of physical activity in older people called Sod Seventy, is a firm advocate of the importance of walking as a means of fitness.

Regular movement is key

The regularity of movement is also key; for example, our research is showing that a session at the gym doesn’t make up for a day of sitting down for long periods of time in the office. A study carried out in nursing homes which compared the impact of sitting, walking for various amounts of time and standing up at frequent intervals, saw the biggest impact on bone and joint health in the group who stood up regularly. This highlights the fact that it’s regular movement that is the key.

All the evidence points towards the fact that inactivity has a negative impact on the health or our joints and muscles, and is likely to contribute to musculoskeletal conditions and decline as we enter older age.

However, the future need not be so bleak. Our researchers are committed to increasing our understanding of how we can age healthily and maintain good function in our joints, and are looking at the biological causes of ageing, including the biological processes that are affected by inactivity. 

They're also looking at the benefit of different diets, including the well-publicised 5:2 diet, and the effect this has on the body. 

How can we get Britain moving?

It’s all very well saying that we should all be moving around more, but getting people to comply is a difficult task. Studies so far which have looked at how to motivate adults, particularly those affected by arthritis, have shown promising results. To many people the word ‘exercise’ itself is a barrier, as it conjures up the image of sporty-looking people pounding the pavements, which they may not identify with. Helping people to understand that increasing their activity levels could be as simple as getting up and walking around the room can be helpful.

However, there are currently no guidelines to refer to on what kinds and how much activity is beneficial, and therefore it’s hard to give advice. Encouraging people to exercise, especially when they’re in pain, is also challenging. Researchers at our ageing centres are building links with motivational psychologists working at our pain centre in Nottingham to identify the best way to encourage people with arthritis to exercise. 

The number one reason people give for not exercising is not having time. A research team at the centre are studying the benefit of short, high-intensity workouts and have found that these can be as beneficial as 40 minutes of regular exercise and can be easier for people to fit into a hectic schedule. Studies have also shown that the elderly prefer shorter bouts of more intensive exercise.Short, high-intensity workouts can be as beneficial as 40 minutes of regular exercise.

The director of the centre for musculoskeletal ageing research in Birmingham, Professor Janet Lord, has a mantra that ‘old age should be enjoyed not endured.’ She has, incidentally, a ‘standing’ desk, in a bid to stop herself sitting down for long periods of time. Professor Lord says: “We understand now that the amount of time we spend sitting is really bad for us – so yes, I’m putting into practice what I preach!

“Our research is starting to show if you don’t take the stairs, if you don’t walk enough, if you spend too much time sitting down watching TV, all these things are associated with an increase of inflammation in the body.”

Inflammation is regarded as increasingly important on the development of osteoarthritis, and the message coming out of the centres’ research is that inactivity may be one of the driving forces of osteoarthritis.

Defining exercise guidelines 

The fact that that frequency of exercise seems to be more important than rather than intensity may be encouraging, especially to those who dread the thought of traditional forms of exercise. But one of the challenges faced is to define exactly what is meant by exercise and physical activity – and how to encourage people to meet these guidelines. Targeting this seems relatively straightforward on the surface; however there’s currently a gap in knowledge regarding what advice to give.

Both of our ageing centres have a raft of innovative research projects lined up which will help define and refine specific exercise messages for older people – other than the generic call to action that ‘exercise is good for you.’

For example, there are clinical studies planned looking at:

• the effects of sitting on the body’s muscles and joints
• how daily protein intake and resistance exercise can improve muscle strength in people with the muscle-weakening condition sarcopenia
• whether lightweight shoes that mimic barefoot walking can increase confidence in walking in older people by improving strength and balance.

Arthritis Today will be bringing news of these studies once they get under way.

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The MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research is based at the Universities of Birmingham and Nottingham.

The MRC-Arthritis Research UK Centre for Integrated Research into Musculoskeletal Ageing is based at the Universities of Liverpool, Newcastle and Sheffield.

Both centres are funded for five years to the tune of £5m.

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